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Prognostic Significance of Carotid and Lower Extremity Artery Stenosis in Patients With High and Very High
V V Genkel1, A S Kuznetsova1, E V Lebedev1
1South Ural State Medical University, Chelyabinsk.
Insights
In high-risk patients, lower-extremity artery stenosis of 35% or more is a significant predictor of severe cardiovascular complications. Carotid artery stenosis did not show a significant association with these adverse outcomes.
Area of Science:
- Vascular Medicine
- Cardiovascular Disease Prediction
- Atherosclerosis Research
Background:
- Patients at high and very high risk of cardiovascular complications (CVC) require accurate prognostic markers.
- The prognostic significance of arterial stenosis degree in different vascular beds is not fully elucidated for this population.
Purpose of the Study:
- To investigate the prognostic value of carotid and lower-extremity artery (LEA) stenosis in predicting severe CVC.
- To determine if the degree of stenosis in these arteries independently predicts adverse cardiovascular events.
Main Methods:
- Prospective study of 214 patients (aged 40-67) at high/very high CVC risk.
- Duplex ultrasound of carotid arteries and LEA, with comprehensive laboratory tests.
- Composite endpoint: CVC death, nonfatal myocardial infarction/stroke, coronary revascularization over a median 32-month follow-up.
Main Results:
- Atherosclerotic plaques were found in 89.3% of patients.
- Carotid stenosis ≥35% was not significantly associated with composite endpoint events (RR 1.22, p=0.607).
- LEA stenosis ≥35% significantly increased the risk of CVC by 2.51 times (RR 2.51, 95% CI: 1.02-6.23, p=0.044).
Conclusions:
- Lower-extremity artery stenosis ≥35% is an independent predictor of severe CVC in high-risk patients.
- LEA stenosis demonstrated 69.4% sensitivity and 61.8% specificity for predicting severe CVC.
- Carotid artery stenosis did not independently predict severe CVC in this cohort.
Abstract:
Aim To study prognostic significance of the degree of stenosis of carotid and lower-extremity arteries (LEA) in patients at high and very high risk of cardiovascular complications (CVC).Material and methods The study included men and women aged 40-67 years at high and very high risk of CVC. Duplex ultrasound scanning of carotid arteries and LEA was performed for all patients. Laboratory tests included measurements of glucose, glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, uric acid, creatinine with estimation of glomerular filtration rate (GFR) using the CKD-EPI Creatinine Equation formula, and high-sensitivity C-reactive protein (hsCRP). Composite endpoint was death from CVC, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization.Results The study included 214 patients from groups of high and very high risk of CVC. Median age of patients was 59.0 [53.2; 64.0] years. A very high risk was identified in 141 (65.8 %) patients and a high risk of CVC in 73 (34.1 %). Atherosclerotic plaques in at least one vascular bed were found in 191 (89.3 %) patients. Duration of the follow-up period was 32.0 [13.7; 49.1] months. Outcomes comprising the composite endpoint were observed in 36 (16.8 %) patients. Presence of carotid stenosis ≥35 % was not statistically significantly associated with the occurrence of outcomes comprising the composite endpoint (relative risk, RR: 1.22; 95 % confidence interval, CI: 0.56-2.66; p=0.607). In contrast, the presence of LEA stenosis ≥35 % was associated with a 2.51 times increased RR of CVC (95 % CI: 1.02-6.23; p=0.044).Conclusion In patients from the groups of high risk and very high risk of CVC, the presence of LEA stenosis ≥35 % predicted the development of severe CVC with a 69.4% sensitivity and a 61.8% specificity. The presence of LEA stenosis ≥35 %, but not of carotid arteries, was an independent predictor of severe CVC (RR, 2.51; 95 % CI: 1.02-6.23; p=0.044) after adjustments for sex, age, presence of arterial hypertension, diabetes mellitus, ischemic heart disease, obesity, smoking, LDL-C, GFR, and drug therapy.
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