Carotid plaque is associated with increased cardiac mortality in patients with coronary artery disease
Hyun Woong Park1, Wan Ho Kim, Ki-Hong Kim
1Division of Cardiology, Konyang University Hospital, Daejeon, South Korea.
Insights
Carotid plaque presence strongly predicts future cardiac death and major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD). This finding highlights its importance for secondary prevention strategies in CAD patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- The association between carotid plaque and cardiovascular events in coronary artery disease (CAD) patients remains debated.
- Evaluating carotid plaque's impact on long-term clinical outcomes in CAD is crucial for risk stratification.
Purpose of the Study:
- To assess the prognostic value of carotid plaque for long-term clinical outcomes in patients with established CAD.
- To compare the predictive power of carotid plaque versus carotid intima-media thickness (CIMT) in this population.
Main Methods:
- 1390 patients with proven CAD underwent carotid scanning.
- Follow-up for major adverse cardiovascular events (MACE) including death, myocardial infarction, stroke, and revascularization over a mean of 54.2 months.
Main Results:
- Patients with carotid plaque were older and had more cardiovascular risk factors.
- Carotid plaque presence significantly predicted cardiac death, hard MACE, and total MACE on multivariate analysis.
- Carotid intima-media thickness (CIMT) predicted only total MACE.
Conclusions:
- Carotid plaque is a significant predictor of future cardiac death and MACE in CAD patients.
- Carotid plaque offers additional prognostic value for secondary prevention in CAD, exceeding that of CIMT.
Background:
It is still controversial whether carotid plaque is associated with cardiovascular events in patients with coronary artery disease (CAD). The aim of the present study is to evaluate the impact of carotid plaque on long term clinical outcomes especially in patients with CAD.
Methods:
The study population consisted of 1390 consecutive patients with angiographically proven CAD. All subjects underwent carotid scanning 1 day before or after coronary angiogram and were followed up for major adverse cardiovascular events (MACE; death, myocardial infarction, stroke, revascularization, restenosis and hospitalization for heart failure) during a mean of 54.2 ± 23.9 months.
Results:
Patients with carotid plaque (n=433) were older, had higher prevalence of cardiovascular risk factors and acute coronary syndrome (34.2% vs. 24.6%, p<0.001) than those without carotid plaque (n=957). On univariate analysis, the presence of carotid plaque was a predictor of cardiac death, hard MACE (death, myocardial infarction and stroke) and total MACE, whereas carotid intima-media thickness (CIMT) was a predictor of total MACE. Multivariate analysis revealed that carotid plaque was associated with cardiac death (HR 6.99, 95% CI 1.88-25.95, p=0.004), hard MACE (HR 1.89, 95% CI 1.18-3.04, p=0.008) and total MACE (HR 1.47, 95% CI 1.13-1.90, p=0.004), whereas CIMT was associated only with total MACE (HR 1.39, 95% CI 1.06-1.81, p=0.017).
Conclusions:
Carotid plaque is a strong predictor of future cardiac death and MACE in patients with CAD. This study suggests that carotid plaque has additional value for secondary prevention and more important prognostic factor than CIMT in patients with CAD.
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