1\u2005Long-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

Abstract

Background The long-term clinical impact of carotid plaque and carotid plaque burden (CPB) in patients with new onset suspected stable angina beyond stress echocardiography (SE) with no history of coronary artery disease (CAD) is not known. Methods Consecutive patients referred for SE underwent simultaneous carotid ultrasonography to assess CPB. Patients were prospectively followed up for major adverse events (MAE). Results Of the 592 patients, 573 (age 59±11, 45% male) could be followed up. During a mean follow up of 7±1.2 years, 85 patients had first MAE (all-cause mortality and acute myocardial infarction: 67 (hard events) and 18 unplanned revascularisation). On multivariate Cox regression analysis, pre-test probability (PTP) of CAD, peak wall thickness scoring index (pWTSI) and CPB predicted MAE (p<0.0001 for all); however, only CPB retained significance for both hard events and hard cardiac events (p=0.008 and 0.001, respectively) (table 1A-B). MAE and hard events were least in patients with normal SE and absent carotid plaque (annualised event rate: 1.1% and 1.01%respectively) with significant increase in normal SE and plaque disease (2.4% and 2.05%, p=0.004 and 0.01 respectively) (figure 1A-B). Presence of plaque did not impact on these outcomes in abnormal SE.Abstract 1 Figure 1 Kaplan-Meier curves of combination of stress echocardiography and carotid ultrasonographyAbstract 1 Table 1 Cox regression analysis for the prediction of (A) Major adverse events; (B) Hard events CI: Confidence interval, CPB: Carotid plaque burden, HR: Hazard ratio, PTP: Pre-test probability, pWTSI: peak wall thickness scoring index Conclusion In patients with suspected stable angina, carotid atherosclerosis and myocardial ischemia in combination provide synergistic MAE information long term but atherosclerosis predicted hard events beyond myocardial ischemia particularly in patients with normal SE. Conflict of Interest None