Korean Circ J.  2015 Jan;45(1):28-37. 10.4070/kcj.2015.45.1.28.

Analysis of Carotid Ultrasound Findings on Cardiovascular Events in Patients with Coronary Artery Disease during Seven-Year Follow-Up

• Yuk HB
• Park HW
• Jung IJ
• Kim WH
• Kim KH
• Yang DJ
• Park YH
• Kim YK
• Song IG
• Bae JH

• KMID: 2223843
• DOI: http://doi.org/10.4070/kcj.2015.45.1.28

Abstract

BACKGROUND AND OBJECTIVES
Both carotid intima-media thickness (CIMT) and carotid plaque are important factors in the primary prevention of cardiac disease. However, it is unclear which one is more important for prognosis, especially in patients with coronary artery disease (CAD).
SUBJECTS AND METHODS
In total, 1426 consecutive CAD patients, proven by angiography, were followed-up for a mean of 85 months. The study population was divided into four groups depending on the CIMT (> or =0.83 mm, >95 percentile in Korea) and the presence or absence of carotid plaque.
RESULTS
Patients with carotid plaque and thick CIMT (n=237, 16.6%) had a higher prevalence of hypertension, diabetes mellitus, and dyslipidemia than those had plaque and thin CIMT (n=213, 14.9%), those without plaque and thick CIMT (n=265, 18.6%) and those without plaque and thin CIMT (n=711, 49.9%). The patients with carotid plaque and thick CIMT group had a higher cardiac mortality rate (20.7% vs. 13.1%, 9.4% and 3.9%, respectively, p<0.001) and higher major adverse cardiovascular events (MACE) including death, acute myocardial infarction, and stroke (27.8% vs. 18.8%, 15.5% and 9.3%, respectively, p<0.001) than any other groups. Multivariate Cox regression analysis showed that the presence of carotid plaque with thick CIMT had the highest hazard ratio (HR) compared to other groups (HR 2.23 vs. 1.81, 2.01) for cardiac mortality. Also, carotid plaque had a higher HR than CIMT for mortality (HR 1.56 vs. 1.37) and MACE (HR 1.54 vs. 1.36) in the total study population.
CONCLUSION
Carotid plaque is a more important prognostic factor than CIMT in patients with CAD, and adding a thick CIMT to carotid plaque increases the prognostic power for cardiac events.

Keyword

Carotid artery plaque; Carotid intima-media thickness; Coronary artery disease; Death

MeSH Terms

Angiography
Carotid Intima-Media Thickness
Carotid Stenosis
Coronary Artery Disease*
Diabetes Mellitus
Dyslipidemias
Follow-Up Studies*
Heart Diseases
Humans
Hypertension
Mortality
Myocardial Infarction
Prevalence
Primary Prevention
Prognosis
Stroke
Ultrasonography*

Figure

• 

  Fig. 1 Kaplan-Meier survival curve (A, B, D, and E) and risk-adjusted Kaplan-Meier curve (C) after stratifying subjects into 4 groups according to CIMT and presence of carotid plaque during long-term follow-up. A and B: major adverse cardiovascular event (MACE) and death rate were significantly higher in patients with carotid plaque than those without carotid plaque and higher in those with thick CIMT than in those in the thin CIMT group. C: mortality risk was also highest in the thick CIMT with carotid plaque group followed by those with carotid plaque and thin CIMT, those without carotid plaque and thick CIMT, and those without carotid plaques and thin CIMT in risk-adjusted Kaplan-Meier curve analysis. D: acute myocardial infarction (AMI) rate showed no significant difference between the 4 groups. E: stroke rate was significantly higher in patients with thick CIMT and carotid plaque compared to those with thin CIMT and without carotid plaque. CIMT: carotid intima-media thickness.

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