Elective coronography presents low diagnostic yield for obstructive coronary artery disease (CAD). Better strategies for CAD screening are required to reduce unnecessary invasive procedures.

We aim to determine whether non-invasive aortic stiffness assessment improves diagnostic accuracy of CAD screening by reducing the number of false-positive results of cardiac stress test.

A cross-sectional study was conducted from January 2013 to September 2014 in our medical center. Electrocardiogram (ECG) stress test coupled with nuclear imaging was performed in 367 consecutive patients routinely followed-up, for myocardial ischemia screening. Aortic pulse wave velocity (PWV) was assessed by applanation tonometry in overall population. Forty-two patients underwent elective coronography because of ischemia. Theoretical PWV was calculated according to age, blood pressure and gender. Results were expressed as an index ([measured PWV-theoretical PWV]/theoretical PWV) for each patient.

Ten patients presented with obstructive CAD, 16 patients had non-obstructive CAD and 16 patients had normal coronary angiography. PWV index and severity of CAD were positively correlated (P=0.001). All patient with obstructive CAD had positive PWV index. When considering retrospectively PWV index, false positive results of cardiac stress test were significantly reduced (P<0.001). Twenty-three procedures may have been avoided in the present study cohort (Fig. 1).

The salient finding of this study was that, in patients with known or suspected CAD, routinely followed-up, aortic PWV index may be considered as clinically useful to reduce the rate of unnecessary invasive angiographies. The clinical relevance of this individualized decision approach should be confirmed in a large-scale study. Prospective studies shall have the potential to further evaluate PWV index as a marker of CAD.