Abstract 11843: Comparison of Prognostic Value Between Carotid Plaque Score and Intima-Media Thickness in Patients With Acute Coronary Syndrome

Abstract

Introduction: Although both carotid plaque score (cPS) and intima-media thickness (cIMT) determined by carotid ultrasounds have been shown to reflect the severity of coronary atherosclerosis, few data exist regarding the direct comparison of their prognostic values in patients with established atherosclerotic vascular disease. Hypothesis: Calculation of cPS which is the reflection of the cumulative atherosclerotic burden of carotid artery is superior in predicting future cardiovascular events compared with only measurement cIMT in common carotid artery. Methods: We examined 263 patients (195 male; mean age, 68±11 years) with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention. The cPS was computed by summing the maximal thickness of plaques in each segment on both side (a + b + c + thickness of the contralateral plaques in each segment on both sides; Figure A). The primary endpoint of this study was major adverse cardiovascular and cerebrovascular events (MACCE) defined as all-cause death, myocardial infarction, stoke, target vessel revascularization, and coronary artery bypass grafting. Renal function was determined by estimated glomerular filtration rate (eGFR). Results: During follow-up duration (median 3.8 years, interquartile range: 1.2 to 6.1 years), 95 MACCE were occurred. Multivariate Cox proportional hazard regression analysis revealed that eGFR (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.66-0.99) and cPS (HR, 1.33; 95% CI, 1.05-1.69) with a 1-SD increase were significantly associated with MACCE, whereas, cIMT was not. Stratification of patients based on the tertiles of cPS was shown in Figure B. Addition of either cPS or cIMT over the eGFR changes C-statistic with nonsignificant. However, the addition of cPS to eGFR significantly improved net reclassification index (0.28, p <0.05), but not cIMT. Conclusions: The cPS provides superior risk stratification in patients with ACS compared with cIMT.