3040Plaque burden, but not the severity of carotid stenosis, predicts adverse cardiovascular events in patients at high and very high cardiovascular risk

Abstract

Abstract Introduction According to the current guidelines the visualization of atherosclerotic plaques in the carotid arteries is the only option that carotid ultrasound provides for the assessment of cardiovascular risk (CVR). The direction devoted to the development and implementation of markers based on the quantification of atheroma, is promising. Purpose The aim of the study was to evaluate the prognostic value of various markers of carotid atherosclerosis (plaque, carotid total plaque area (cTPA) and carotid stenosis) in patients at high and very high CVR. Methods The study included patients aged 40–75 years at high and very high CVR. All patients underwent carotid duplex ultrasound. The presence of carotid plaque was assessed according to Mannheim consensus. The percentage of stenosis was measured planimetrically in the B-mode by the diameter in the cross section of the vessel. cTPA was estimated in the longitudinal position, which allows to achieve the best visualization of plaque, the area of plaque was measured in the manual trace mode. These measurements were performed for each rendered plaque, followed by the calculation of the total value. The combined endpoint was cardiovascular death, non-fatal myocardial infarction or unstable angina (which required hospitalization), non-fatal stroke, and coronary revascularization. Results The study included 100 patients at high and very high risk. The duration of the follow-up period was 24.4 (14.1–34.3) months. The events constituting the combined endpoint occurred in 34 (34%) patients: cardiovascular death was recorded in 7 (7%) patients; non-fatal myocardial infarction or stroke in 3 (3%) patients; unstable angina, which required hospitalization in 24 (24%) patients, while emergency coronary angiography was performed in 8 (8%) patients, coronary artery stenting was performed in 3 (3%) cases. The presence of carotid plaque in accordance with Cox regression after adjusting for factors such as sex, age, smoking, hypertension, BMI, eGFR, LDL-c and HbA1c, RR of adverse cardiovascular events was 10.5 (95% CI 1.27–86.5; p=0.008; see Figure 1). The optimal cut-off values of cTPA and carotid stenosis were determined by ROC-analysis. An increase in cTPA ≥69 mm2 corrected for sex, age, smoking, hypertension, BMI, eGFR, LDL-c, HbA1c, and the presence of carotid plaque was associated with an increase in the RR of adverse cardiovascular events by 5.86 times (95% CI 2.09–16.4; p=0.001; see Figure 1). Also, there were no statistically significant associations between carotid arteries stenosis and adverse cardiovascular events (RR 1.29; 95% CI 0.61–2.76; p=0.504). Kaplan–Meier curves for cTPA, stenosis Conclusion In patients at high and very high cardiovascular risk among carotid ultrasound parameters the presence of carotid plaque and cTPA, but not the degree of stenosis, had an independent predictive value regarding the development of adverse cardiovascular events.