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

Jacek Gacoń; Tadeusz Przewlocki; Jakub Podolec; Rafal Badacz; Piotr Pieniazek; Wojciech Ryniewicz; Krzysztof Żmudka; Anna Kabłak-Ziembicka

doi:10.5114/aic.2019.81705

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

Postepy Kardiol Interwencyjnej. 2019;15(1):74-80. doi: 10.5114/aic.2019.81705. Epub 2019 Mar 4.

Authors

Jacek Gacoń^{1

2}, Tadeusz Przewlocki², Jakub Podolec², Rafal Badacz², Piotr Pieniazek², Wojciech Ryniewicz³, Krzysztof Żmudka², Anna Kabłak-Ziembicka²

Affiliations

¹ Department of Invasive Cardiology, E. Szczeklik's Hospital, Tarnow, Poland.
² Department of Interventional Cardiology, Jagiellonian University School of Medicine, the John Paul II Hospital, Krakow, Poland.
³ Department of Dental Prosthetics, Institute of Dentistry, Jagiellonian University School of Medicine, Krakow, Poland.

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.

Keywords: atherosclerosis progression; carotid intima-media thickness; coronary artery diseases; major adverse cerebral and coronary events; myocardial infarction; symptom recurrence.