The role of serial carotid intima-media thickness assessment as surrogate marker of atherosclerosis control in patients with recent myocardial infarction

Abstract

Introduction Despite percutaneous coronary intervention (PCI), patients after their first myocardial infarction (MI) are at high risk of ischemic event recurrence. Therefore, there is a need for objective markers of adequate atherosclerosis control, independent of prescribed pharmacotherapy and patients’ compliance. Such a potential indicator of major adverse cerebral and coronary event (MACCE) risk might be change in carotid intima-media thickness (CIMT), which indicates atherosclerosis growth. Aim To evaluate the potential associations between CIMT changes and the incidence of MACCE and recurrent MI. Material and methods The CIMT assessments at baseline and during 2 follow-up visits were performed in 215 patients admitted with MI, in whom PCI was performed for an index lesion, followed by best medical treatment. The incidences of MACCE (cardiovascular death, recurrent MI, ischemic stroke) and new onset angina were recorded prospectively. Results The MACCE were recorded in 65 (30.2%) patients and angina due to coronary lesion progression (CLP) in 27 (12.5%) patients. Although initial CIMT values were similar in patients who suffered MACCE vs. MACCE-free patients (1.43 ±0.40 vs. 1.45 ±0.44 mm; p = 0.486), patients in whom MACCE occurred had greater annual CIMT growth as assessed at the first (0.024 ±0.12 vs. 0.009 ±0.16 mm/year; p < 0.001) and subsequent follow-up visit (0.050 ±0.1 vs. 0.001 ±0.1 mm/year; p < 0.001), in mean 36.5 ±29.3 and 53.3 ±37.1 months, respectively. An optimal cut-off value for annual CIMT change of > 0.003 mm/year (sensitivity: 84.5%, specificity: 49.3%) for MI plus CLP (AUC = 0.673) occurred an independent indicator of MACCE (HR = 3.00; 95% CI: 1.496–6.016), recurrent MI (HR = 4.59, 95% CI: 1.591–13.217), and MI plus CLP (HR = 3.50, 95% CI: 1.759–6.964). Conclusions Annual CIMT change might be a potentially valuable marker of atherosclerosis response to post-MI treatment.

Corneal confocal microscopy identifies greater corneal nerve damage in patients with a recurrent compared to first ischemic stroke

“…Individual vascular risk factors such as diabetes, hypertension, smoking, dyslipidemia and metabolic syndrome are associated with the risk of a first and recurrent ischemic stroke [5-7, 13, 43]. A recent study has shown that a greater increase in carotid intima media thickness (IMT) was associated with an increased incidence of major adverse cerebral and coronary events [44]. Similarly, in the J-STARS (Japan Statin Treatment Against Recurrent Stroke) study, patients with the greatest baseline IMT were at the highest risk of recurrent stroke, which was partially ameliorated by treatment with pravastatin [45].…”

Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography

“…21 Methodological limitations of this study notwithstanding, our expert panel recommends against serial CIMT measurements for CVD risk stratification especially when not meeting the threshold for diffuse plaque ($1.5 mm). We recognized that based on limited or anecdotal evidence, there may be value in serial CIMT measurements in the hands of some experts for research, 22,23 , monitoring of progression or regression in specific cases 24,25 , and as a potential tool to alter patient behavior. 26 Additionally, it is possible that over time, an individual patient may have a CIMT value that has increased to $1.5 mm, signifying the development of diffuse atherosclerotic plaque by our definition; however the clinical utility of such long term CIMT monitoring is not yet established.…”

Predictive value of carotid artery ultrasonography for the risk of coronary artery disease

“…Since atherosclerosis increases the risk of cardiovascular disease, and measurements can be performed noninvasively by carotid artery ultrasonography, this method should be included in screening algorithms for the prevention of cardiovascular events 35 . Gacon et al demonstrated the value of serial carotid IMT measurements as a surrogate marker of atherosclerosis control in patients with recent MI 36 . IMT has been consistently associated with CHD in previous research, but its clinical usefulness in predictive risk assessment is limited 37 .…”