Abstract 17662: High-risk Carotid Atherosclerotic Lesions Identified by CT-angiogram Can Predict Acute Coronary Events
Introduction: Computed Tomography Angiogram (CTA) is increasingly being utilized as an imaging tool for the characterization of atherosclerotic lesions of major arteries. Our recent ex vivo study has shown the presence of high-risk necrotic coronary lesions in the subjects who had suffered sudden cardiac death following acute stroke. Although stroke and myocardial infarction (MI) have shared risk factors and outcomes, there are no data available to predict the coronary events based on the high-risk features identified in the carotid arteries by non-invasive CTA of the neck vessels.
Methods: We examined the carotid CTAs of 485 patients who had presented to our tertiary stroke center with symptoms suggestive of TIA or stroke. Using reformatted CT images, we first characterized the atherosclerotic plaques of the common, internal and external carotid arteries. We then examined the follow up events of these 485 patients for 12-months to evaluate the significance of newly identified carotid lesions for the subsequent development of acute coronary events (ACS). Carotid lesions were defined in terms of the degree of stenosis, calcifications (speckled or eccentric), presence of non-calcified plaques, positive remodeling, and presence of a Napkin-Ring Sign.
Results: Our data analysis using Mann-Whitney U tests showed that presence of speckled carotid calcifications visualized by CTA was strongly associated with increased risk of obstructive coronary artery disease or ACS within 12-months (p<0.001). Patients who had ACS within a year were more likely to have higher number of calcific speckles (10-speckles in ACS group vs 4-speckles in non-ACS group; P<0.05) in their carotid arteries. Receiver-Operating Curve analysis showed that presence of more than four calcific speckles in the carotid arteries portends higher likelihood of developing ACS within 12-months (P<0.05).
Conclusions: This novel study shows that presence of speckled carotid calcifications in patients with symptoms of TIA or stroke can predict the higher risk of developing ACS within 12-months. In fact, Four or more speckles was the optimal cut-off point associated with the higher likelihood of developing ACS within 12-months.
Author Disclosures: K. adib: None. A. Carmona Rubio: None. R. Karki: None. N. Madam: None. G. Gudleski: None. U.C. Sharma: None.
- © 2015 by American Heart Association, Inc.