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

      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 ≥1.25 mm (≥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 ≥1.25 mm (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 ≥1.25 mm is associated with 2.5-fold increased risk of adverse CV events.

      Keywords

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      References

      1. American Heart Association. Heart Disease and Stroke Statistics–2009 Update. Centers for Disease Control and Prevention (CDC)/NCHS and NHLBI 2005–2006.

      2. Statistics data from World Health Organisation (http://www.who.int/en).

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