The role of carotid intima-media thickness assessment in cardiovascular risk evaluation in patients with polyvascular atherosclerosis

Kablak-Ziembicka, Anna; Przewlocki, Tadeusz; Pieniazek, Piotr; Musialek, Piotr; Sokolowski, Andrzej; Drwila, Rafal; Sadowski, Jerzy; Zmudka, Krzysztof; Tracz, Wieslawa

doi:10.1016/j.atherosclerosis.2009.08.019

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Volume 209, Issue 1 , Pages 125-130, March 2010

The role of carotid intima-media thickness assessment in cardiovascular risk evaluation in patients with polyvascular atherosclerosis

Anna Kablak-Ziembicka
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland
- Corresponding author at: Department of Cardiac and Vascular Diseases, Institute of Cardiology, Collegium Medicum Jagiellonian University in Krakow, 31-202 Krakow, Poland. Tel.: +48 12614 22 87; fax: +48 124234376.
Tadeusz Przewlocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland
Piotr Pieniazek
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland
Piotr Musialek
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland
Andrzej Sokolowski
- University of Economics, Department of Statistics, Krakow, Poland
Rafal Drwila
- Department of Cardiosurgery and Transplantology, Institute of Cardiology, Jagiellonian University, Krakow, Poland
Jerzy Sadowski
- Department of Cardiosurgery and Transplantology, Institute of Cardiology, Jagiellonian University, Krakow, Poland
Krzysztof Zmudka
- Department of Hemodynamics and Angiocardiography, Institute of Cardiology, Jagiellonian University, Krakow, Poland
Wieslawa Tracz
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland

Received 21 May 2009; received in revised form 23 July 2009; accepted 11 August 2009. published online 17 September 2009.

Abstract

In populational studies, carotid intima-media thickness (CIMT) is a valuable tool in the evaluation of cardiovascular (CV) risk. However, there is not much evidence on the relation between CIMT, and CV events in patients who have already undergone revascularization procedures.

Aim

To evaluate the relationship between CIMT, atherosclerosis extent and CV event rates in patients with established atherosclerosis.

Methods and Results

Baseline mean-CIMT was assessed in 652 patients, including 195; 191; 112; 29 with angiographic arterial stenosis ≥50% in 1; 2; 3 or 4 territories (coronary, supraaortic, renal and/or lower limb arteries), who underwent revascularization procedure in ≥1 arterial territory, and in 125 control subjects without significant lesions. For CIMT ≥1.25mm (≥3rd quartile), the sensitivity and specificity of ≥2-territory involvement were 81.6% and 81.9%. CV events occurred in 91(14%) subjects. The Kaplan–Meier 2-year CV event-free survival was 95.6%; 93.1%; 83.8%; 77% in patients with mean-CIMT values in the 1st; 2nd; 3rd and 4th quartile. The independent CV adverse event predictors identified in the multivariate Cox proportional hazard model were: mean-CIMT ≥1.25mm (RR=2.52; CI=1.5–4.24; p=0.001); hs-CRP (RR=1.02; CI=1.0–1.03; p=0.011), claudication (RR=1.58; CI=0.98–2.57; p=0.062), accumulation of ≥4 traditional risk factors (RR=2.02; CI=1.31–3.12; p=0.002), 2-3-vessel coronary artery disease (RR=1.95; CI=1.21–3.14; p=0.006). Inclusion of CIMT into the stratification model significantly improved the prediction of CV event risk (ΔChi²=13.27, p=0.0003).

Conclusions

In patients undergoing revascularization procedure(s), CIMT has an important and independent contribution to further CV risk stratification. The mean-CIMT value ≥1.25mm is associated with 2.5-fold increased risk of adverse CV events.

Keywords: Carotid intima-media thickness, Cardiovascular event rates prediction, Multi-territorial arterial stenoses