Carotid plaque burden is strong predictor of cardiac death in CAD
MedWire News: Ultrasound-detected carotid plaque is a strong predictor of cardiac death, myocardial infarction (MI), and stroke in patients with coronary artery disease (CAD), study results show.
Indeed, carotid plaque emerged as "a more important prognostic predictor than carotid intima-media thickness (CIMT)," report Jang-Ho Bae and colleagues from Konyang University Hospital in Daejeon, South Korea.
They note that CIMT is the most commonly used surrogate marker for atherosclerosis in the general population and is associated with risk for MI, stroke, and coronary heart disease.
Recent studies have suggested that carotid plaque burden may have prognostic power for cardiovascular events similar to or greater than CIMT.
However, previous studies were conducted only in small samples of acute coronary syndrome (ACS) or stable angina patients and were not documented by coronary angiography (CAG).
In the current study therefore the researchers recruited 1390 consecutive patients with angiographically proven CAD. All subjects underwent B-mode ultrasound carotid scanning and were followed-up for major adverse cardiovascular events (MACE; death, MI, stroke, revascularization, restenosis, and hospitalization for heart failure) for an average of 4.5 years.
Bae et al report that 433 patients had carotid plaque defined as a focal structure encroaching into the arterial lumen by at least 50% of the surrounding IMT value, or with a thickness greater than 1.2 mm.
Patients with carotid plaque were older and had higher prevalences of cardiovascular risk factors and ACS than those without carotid plaque.
Multivariate Cox regression analysis showed that carotid plaque was an independent predictor of cardiac death (hazard ratio [HR]=6.99), 'hard' MACE (death, MI, and stroke; HR=1.89) and total MACE (HR=1.47). Meanwhile, CIMT was associated only with total MACE (HR=1.39).
These associations between carotid plaque and outcomes remained after adjustment for age, gender, ejection fraction, prior MI, hypertension, diabetes mellitus, dyslipidemia, smoking, acute coronary syndrome (ACS), PCI of target lesion and thick CIMT.
Discussing the findings, the researchers note that there is discrepancy over how different morphologies of carotid plaques impact clinical outcomes.
"Further study using more objective criteria in determining plaque characteristics is needed to evaluate the impact of carotid plaque characteristics on the adverse cardiac events," they suggest.
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By Andrew Czyzewski