Carotid plaque score, independent risk factor for cardiovascular events and mortality after acute coronary syndrome

Abstract

The carotid plaque score (CPS) is the sum of max endoluminals eaves of all atherosclerostic plaques of Common carotids carotid, bifurcations and Internal Carotides. It reflects the atherosclerotic load of the carotid arteries. As intima media thickness, it is strongly related to mortality risk in hypertensive patient and the increase of stroke risk. It is also an independant predictor of coronary heart disease and has a strong link with the SYNTAX score. By a prospective study, recruiting consecutive three hundred thirty-six inpatient coronary care unit for acute coronary syndrome, the aim is to evaluate the impact of a high CPS on mortality and cardiovascular events at 6 and 12 months of follow-up. Among patients (Men = 69.0%; mean age = 63.3y), The carotid bulb is the most frequent location of atherosclerotic plaques: 207 patients (61.3%). In our study population, 20.8% have cerebrovascular disease and 16.1% peripheral artery disease (defined by Anckle brachial index < 0.9). One hundred and seven patients (31.8%) have an atherosclerotic bulb plaque of more than 3 mm. A CPS greater than 7 mm is objectified in 91 patients (27.1%) and a significant carotid stenosis is seen in 57 patients (16.7%). A High CPS is significantly related with the presence of multitroncular coronary disease. CPS greater than 12 mm appears as an independent and powerful predictor of mortality and cardiovascular events in medium term in patients with acute coronary syndrome. The hazard ratio of High CPS (CPS > 12 mm) for cardiovascular events at 6 and 12 months of hospitalization are respectively 3,5 (95% CI:1.75–7.13) and 3.4 (95% CI:1.78–6.5). The hazard ratio of High CPS (CPS > 12 mm) for cardiovascular mortality at 6 and 12 months of hospitalization are 4.23 (95% CI:1.42–12.66) and 5.77 (95% CI:2.30–14.47) respectively.