Abstract 6061: Femoral Atherosclerotic Plaque Characteristics are Independent Predictors for Major Systemic Cardiovascular Events
There is an urgent need for prognostic markers that will help to identify the patient who is at risk for primary and secondary manifestations of atherosclerosis. We study a concept that is based on the hypothesis that destabilization of atherosclerotic plaques is a systemic process rather than a local inflammatory process. Therefore, local plaques could hide a fingerprint that reflects the stability of atherosclerotic lesions in the whole vascular tree. In this sub study we investigated if the morphology of femoral artery plaques, harvested during endarterectomy, has predictive value for the occurrence of cardiovascular events. Femoral artery endarterectomy specimens of 280 consecutive patients, who were operated for peripheral arterial occlusive disease, were assembled in the vascular biobank with a longitudinal study design. Atherosclerotic plaques were assessed for histological characteristics (collagen, calcifications, smooth muscle cells, macrophages, lipid core and thrombus). All patients underwent follow-up for three years to assess cardiovascular events after initial operation. The primary endpoint was defined as the composite of cardiovascular death, myocardial infarction, stroke, and coronary intervention. Primary endpoints occurred in 12.9% (36/280) with a mean follow-up time of 25 months. There was no relation between the plaque amount of collagen (hazard ratio=0.49 [0.21–1.12]), calcifications (HR=1.33 [0.64 –2.77]), smooth muscle cells (HR=0.54 [0.26 –1.10]) or macrophages (HR=1.66 [0.81–3.42]) and the occurrence of a major event. However, the presence of thrombus (HR=4.00 [1.23–13.08]) and large lipid core size in the local plaques (HR=2.28 [1.17– 4.44]) were positively related with post-operative major events in the other vascular territories. Multivariate cox regression analysis showed that presence of a large lipid core and thrombus; in a locally dissected femoral plaque were both independent predictors for occurrence of major events after initial operation.
Conclusion: We show that histological characteristics (large lipid core and presence of thrombus) of single local femoral atherosclerotic plaques hide a prognostic value for major cardiovascular events in other vascular territories.