Long-Term Prognostic Value of Simultaneous Assessment of Atherosclerosis and Ischemia in Patients with Suspected Angina: Implications for Routine Use of Carotid Ultrasound during Stress Echocardiography.
J Am Soc Echocardiogr
; 33(5): 559-569, 2020 05.
Article
em En
| MEDLINE
| ID: mdl-32222481
ABSTRACT
BACKGROUND:
While the impact of carotid plaque on cardiovascular events is well investigated in asymptomatic epidemiologic studies, the long-term clinical impact of carotid plaque and its burden (CPB) in patients with new-onset suspected stable angina with no history of coronary artery disease beyond stress echocardiography (SE) is not known. We sought to investigate this with a prospective study, where patients were followed up for adverse events.METHODS:
Consecutive patients referred for SE underwent simultaneous carotid ultrasonography to assess CPB, defined as the total number of carotid plaques per patient. Stress echocardiography was reported off-line using a 17-segments model and four-point wall thickening scoring. Peak wall thickening scoring index was the sum of scores of each segment divided by 17.RESULTS:
Of the 592 patients, 573 (age 59 ± 11, 45% male) had follow-up data. During a mean of 7.2 years, 85 patients had a first major adverse event (all-cause mortality and acute myocardial infarction 68 had hard events and 17 had unplanned revascularization). On multivariate Cox regression analysis, pretest probability of coronary artery disease (P = .048), peak wall thickening scoring index (P < .0001), and CPB (P < .0001) predicted major adverse events; however, only CPB retained significance for both hard events and hard cardiac events (P = .001 and < .0001, respectively). Major adverse events and hard events were the least in patients with normal SE and absent carotid plaque (annualized event rate 1.1% and 1.02%, respectively), with a significant increase in normal SE and carotid plaque disease (2.4% and 2.05%, P = .004 and P = .01, respectively). The presence of plaque did not have an impact on these outcomes in an abnormal SE cohort.CONCLUSIONS:
In patients with suspected stable angina with no history of cardiovascular disease, carotid atherosclerosis and myocardial ischemia detected by ultrasound provided synergistic information for the long-term prediction of events, but atherosclerosis predicted hard events beyond myocardial ischemia, particularly in patients with a normal SE.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
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Aterosclerose
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Angina Estável
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Infarto do Miocárdio
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
J Am Soc Echocardiogr
Assunto da revista:
DIAGNOSTICO POR IMAGEM
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Reino Unido