Abstract 15306: Significantly Higher Prevalence of Carotid Disease Compared to Myocardial Ischemia in Patients Undergoing Simultaneous Stress Echocardiography for Suspected Coronary Artery Disease; Implications for Primary Preventative Therapy
Introduction: Presence of carotid artery disease (increased carotid intima-media thickness (C-IMT) and/or carotid plaque) has been shown to predict cardiovascular risk beyond Framingham Risk Score (FRS). We aimed to explore its prevalence and potential impact on patients’ management, undergoing stress echocardiography (SE) for new onset chest pain without known CAD.
Methods: Consecutive patients with no previous history of CAD referred for SE underwent simultaneous carotid ultrasound. Carotid disease was defined as C-IMT >75th percentile for age and sex, and/or presence of plaque according to Mannheim consensus. Patients underwent coronary angiography based on clinical grounds and SE data.
Results: Of the 566 consecutive patients, (259 male (46%), mean age 59±11 years), 66 (11.7%) demonstrated myocardial ischemia by SE, of which majority (46 patients (70%)) had carotid disease (38 patients (58%) with carotid plaque and 26 patients (39%) with abnormal C-IMT). However, carotid disease was also present in 321 out of 500 (64%) with normal SE (241 (48%) plaque, 194 (39%) abnormal C-IMT). FRS was significantly higher (p<0.0001) in patients with carotid disease (18±9) vs. those without it (12.6±8). Carotid disease was also observed in 187/332 (56%) of patients in low-intermediate FRS and normal SE, of whom 68/187 (36%) had borderline total cholesterol (200-240 mg/dl) and would potentially benefit from re-classification and primary intervention. 72 patients of the total 566 underwent coronary angiography, of which 56 (78%) demonstrated CAD. Subsequently, 32 (44%) patients underwent revascularization. Whilst both carotid disease and plaque showed significant association with CAD and revascularization, after adjustment for all known coronary risk factors and FRS, carotid disease and plaque maintained significant association with revascularization ((p=0.027 & 0.013, respectively).
Conclusion: There is significantly higher prevalence of carotid disease compared to myocardial ischemia in patients undergoing simultaneous SE and carotid ultrasound for suspected CAD. Carotid disease and plaque are associated with incident revascularization. These have implications for primary preventive therapy in low-intermediate FRS group and negative SE.
- © 2012 by American Heart Association, Inc.