Prospective study on the prognostic value of repeated carotid intima-media thickness assessment in patients with coronary and extra coronary steno-occlusive arterial disease

被引:20
|
作者
Gacon, Jacek [1 ,2 ]
Przewlocki, Tadeusz [1 ]
Podolec, Jakub [1 ]
Badacz, Rafal [1 ]
Pieniazek, Piotr [1 ]
Mleczko, Szymon [1 ]
Ryniewicz, Wojciech [3 ]
Zmudka, Krzysztof [1 ]
Kablak-Ziembicka, Anna [1 ]
机构
[1] Jagiellonian Univ Med Coll, John Paul II Hosp, Dept Intervent Cardiol, Krakow, Poland
[2] Edward Szczekl Hosp, Dept Invas Cardiol, Tarnow, Poland
[3] Jagiellonian Univ, Inst Dent, Dept Dent Prosthet, Med Coll, Krakow, Poland
来源
POLISH ARCHIVES OF INTERNAL MEDICINE-POLSKIE ARCHIWUM MEDYCYNY WEWNETRZNEJ | 2019年 / 129卷 / 01期
关键词
change in maximum carotid intima-media thickness; coronary artery diseases; major adverse cerebral and coronary events; peripheral artery disease; prospective evaluation; CARDIOVASCULAR RISK; ATHEROSCLEROSIS RISK; DIABETIC-PATIENTS; VASCULAR EVENTS; PROGRESSION; PLAQUE; ASSOCIATION; PREDICTORS; BIOMARKERS; DRUGS;
D O I
10.20452/pamw.4407
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
INTRODUCTION It is debatable whether the rate of change in carotid intima-media thickness (CIMT) may be used as a risk indicator of major adverse cerebral and coronary events (MACCEs) in patients with either coronary (CAD) and peripheral artery disease (PAD). OBJECTIVES This prospective study aimed to evaluate the association between CIMT changes and the incidence of MACCEs, in patients with symptomatic CAD and PAD. PATIENTS AND METHODS The study comprised 466 patients admitted with steno-occlusive disease, in whom revascularization was performed for an index lesion. Group 1 included 305 subjects with CAD, and group 2, 161 patients with PAD. CIMT was measured at baseline and at a median of 21 and 41 months afterwards. The incidence of MACCE, cardiovascular death (CVD), myocardial infarction (MI), and ischemic stroke was recorded prospectively during 5 years. RESULTS CIMT increased with a mean (SD) progression rate of 0.027 (0.16) mm/y in group 1 and 0.026 (0.17) mm/y in group 2 (P = 0.89). CIMT regression was recorded in 112 patients (36.7%) and 61 patients (37.9%) in groups 1 and 2, respectively, at baseline (P = 0.80), and 82 patients (26.9%) and 42 patients (26.1%) in groups 1 and 2, respectively, in follow-up (P = 0.85). Maintained CIMT regression was independently associated with a reduced risk of MACCEs (hazard ratio [HR], 0.25; 95% CI, 0.15-0.42), MI (HR, 0.32; 95% CI, 0.20-0.51), ischemic stroke (HR, 0.29; 95% CI, 0.18-0.45), and CVD (HR, 0.24; 95% CI, 0.15-0.40), while the CIMT progression rate of 0.056 mm/y was associated with an increased risk of MACCEs (sensitivity, 53.2%; specificity, 72.2%; area under the receiver operating curve, 0.65). CONCLUSIONS Maintained CIMT regression is associated with 68% to 75% reduction in the risk of a cardiovascular event. However, a long-term maintained CIMT regression is achieved in one-fourth of patients with either CAD or PAD.
引用
收藏
页码:808 / 817
页数:10
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