Abstract 12796: Plaque Surface Irregularity and Calcification Length Within Carotid Plaque Predict Secondary Events in Patients With Coronary Artery Disease

Introduction: Although comprehensive risk factor modification is recommended, a uniform management strategy does not necessarily prevent secondary events in patients with coronary artery disease (CAD). Therefore, identification of high-risk patients who may benefit from more intensive interventions may improve prognosis. Carotid ultrasound can reliably identify systemic atherosclerosis, and carotid plaque and intima-media thickness (IMT) are known independent risk factors for CAD. However, it is unclear whether findings on carotid ultrasound can improve prediction of secondary CAD events. Methods: The study population comprised 146 consecutive patients with CAD (mean age, 66 ± 9 years; 126 with angina pectoris, 20 with myocardial infarction). IMT, plaque score, plaque area, plaque surface irregularity, and calcification length (calculated by summing the calcified lesions within each plaque accompanied by acoustic shadow) were measured at baseline. Patients were followed for 10 years to ascertain secondary CAD events. Results: Of 146 patients, secondary CAD events occurred in 63 after a median follow-up of 10 years. In univariate analysis, calcification length (P < 0.05) and plaque surface irregularity (P < 0.01) were associated with secondary CAD events, whereas IMT, plaque score, and plaque area were not. Multiple regression analysis demonstrated that calcification length (odds ratio, 1.06; P < 0.05) and plaque surface irregularity (odds ratio, 3.85; P < 0.01) remained independently associated with secondary CAD events after adjustment for age, sex, diabetes mellitus, dyslipidemia, hypertension, chronic kidney disease, and smoking. Moreover, when patients were divided into 4 groups according to calcification length and presence or absence of plaque surface irregularity, the group with longer calcification and plaque surface irregularity had greater risk of secondary CAD events (relative risk, 3.82; P < 0.05). Conclusions: These findings suggest that the combination of calcification length and plaque surface irregularity has additional value beyond traditional risk classification. Intensive intervention for these high-risk patients may avoid or delay progression of atherosclerosis towards secondary CAD events.