Predictive value of vascular response to cuff inflation–induced pain in the control arm for adverse cardiovascular events

Tao Sun, Yasushi Matsuzawa, Robert J. Widmer, Joerg Hermann, Lilach O. Lerman, Amir Lerman

Research output: Contribution to journalArticlepeer-review


Background: The high incidence rate of cardiovascular (CV) events had led to a comprehensive appraisal for identifying patients who are at risk for CV disease. However, CV traditional risk factors, such as Framingham risk score (FRS), failed exhaustively to predict CV events. Methods: 402 participants (mean age, 58 [12] years; 45% male) using fingertip peripheral artery tonometry at Mayo Clinic in Rochester, Minnesota, were recruited in the present study. Measurements included reactive hyperemia index (RHI) and pain-induced peripheral artery tonometry (PIPAT). Results: After a median follow-up of 3.8 (2.7–7.7) years, 95 CV events occurred. Both first minute PIPAT and RHI were independently associated with events (hazard ratio [HR], 0.77 [95% CI, 0.61–0.98]; P = 0.038 and HR, 0.75 [95% CI, 0.59–0.96]; P = 0.019, respectively). The C statistic values of FRS, FRS + first minute PIPAT, FRS + RHI, and FRS + RHI + first minute PIPAT were 0.704, 0.722, 0.694, and 0.726, respectively. Furthermore, the addition of first minute PIPAT, RHI, and first minute PIPAT + RHI to FRS results in net reclassification improvement (NRI) in the intermediate-risk group (18.1%, P = 0.031; 18.1%, P = 0.035; 21%, P = 0.013). Conclusion: First minute PIPAT is a risk marker for adverse CV. Addition of first minute PIPAT to FRS increased the discrimination in the receiver operating characteristic analysis. It also increased NRI compared with FRS alone.

Original languageEnglish (US)
Article number100728
JournalIJC Heart and Vasculature
StatePublished - Apr 2021


  • Cardiovascular events
  • Framingham risk score
  • Pain-induced peripheral artery tonometry
  • Reactive hyperemia index

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Predictive value of vascular response to cuff inflation–induced pain in the control arm for adverse cardiovascular events'. Together they form a unique fingerprint.

Cite this