Abstract 12997: Meta-Analysis and Systematic Review of the Predictive Value of Carotid Plaque Hemorrhage by Magnetic Resonance Imaging on Cerebrovascular Events
PURPOSE There is evidence that carotid atherosclerotic plaque magnetic resonance imaging (MRI) identifies features that are associated with future cerebrovascular events. However, available data are based on smaller samples with heterogeneous source populations despite a promising value for non-invasive risk stratification. Thus, we conducted a systematic review and meta-analysis to determine estimates of the predictive value of carotid plaque haemorrhage as determined by MRI for cerebrovascular events.
METHOD AND MATERIALS We searched PubMed, EMBASE and the Cochrane Library through February 2012 for studies that followed >35 individuals after baseline MRI. Risk estimates of the presence of plaque haemorrhage for cerebrovascular events (TIA, stroke, amaurosis fugax) were derived in random effect regression analysis and causes of heterogeneity were determined in meta-regression analysis. Also, publication bias was assessed.
RESULTS Among 218 published articles, we identified 8 eligible studies including 689 participants (73.1±2.5 years, 77.9% male) who underwent carotid MRI. The prevalence of plaque haemorrhage at baseline was high (49.0%). Over a median follow-up of 19.6 months a total of 108 cerebrovascular events occurred (15.7% event rate). The presence of plaque haemorrhage was associated with a ~6-fold higher risk for events (HR: 5.69; 95%-CI: 2.98 - 10.87) with a trend for heterogeneity (I2: p=0.07) but no evidence of publication bias (p>0.05). Meta-regression identified covariate adjustment, presence of symptoms, and study quality as sources of heterogeneity (all p>0.05). The event rate in subjects with detectable plaque haemorrhage was 30.6%.
CONCLUSION Carotid plaque haemorrhage on MRI predicts cerebrovascular events despite heterogeneity in populations, endpoints, and categorization of MRI findings. Homogenization of future studies is warranted to allow for sufficient assessment of level of evidence for intervention trials.
- © 2012 by American Heart Association, Inc.