Predictive value of noninvasive markers of atherosclerosis for cardiovascular morbidity and mortality in patients with coronary artery disease (4 years follow-up study)

Abstract

Ankle brachial pressure index (ABI) and carotid artery intima-media thickness (CIMT) and the are non-invasive markers of atherosclerosis and have been shown to reliably predict presence atherosclerotic vascular disease. Purpose: The objective of this study was to examine predictive value of ABI and carotid IMT for cardiovascular morbidity and mortality. Metods: The study included 150 subjects, divided into two groups. The first group consisted of patients with verified coronary heart disease, n = 100 (age: 59,7+/-10,5), who were in a rehabilitation at the Institute <>. Control group consisted of the examinees without coronary disease, n=50. For all patients there was determined: SCORE risk, laboratory analyses, anthropometric measurements, exercise testing, ABI evaluation, color doppler sonography of the carotid arteries. Results: Most patients of the first group had some form of myocardial revascularization (47% surgically accomplished; 43% percutaneous coronary intervention). As the most important factors associated with the number of coronary blood vessels affected by atherosclerosis, multivariate regression analysis singled out ABI value, CIMT, fibrocalcified plaque type, CV risk score and waist-hip ratio. After 4 years, we have successfully contacted 78 examinees from the first group, all examinees from the second group. A major adverse cardiac event (MACE) had 13 (16.7%) patients from the first group, 3 (3.8%) patients had cardiac death, 5% myocardial infarction, 5% new PCI and 2,5% stroke. It was discovered that the patients with MACE had: ABI value significantly lower 0.86+/-0.1 vs 1.02+/-0.2, (p<0,001), CIMT significantly higher 1,08+/-0,2 vs 0,96+/-0,2 (p=0,040), higher percentage of carotid stenosis 49,8+/-17,1 vs 33,5+/-22,1 (p=0,003), more often obesity 62,5% vs 30.6% (p=0,039) and smaller percentage of patients reached submaximal heart rate (SmaxHR) in exercise testing 25% vs 58% (p=0.019). Univariant logistic regression analysis as risk factors for new cardiovascular events were extracted following parameters: ABI <0.9 (p=0.008), CIMT (p=0.038), percentage of carotid stenosis (p=0.013), obesity (p=0.023) and SmaxHR (p=0.024). Kaplan-Meier curve showed that subjects who have ABI<0.9 have a higher mortality rate (logrank=4.028, p=0.045). Cox regression analysis as independent predictors of mortality were identified: ABI<0.9 (p=0.083), body mass index (p=0,08), serum cholesterol (p=0,045), LDL cholesterol (p=0,037) and waist (p=0,02). Conclusion: The CIMT especially ABI may help to identify coronary patients who are at increased risk of subsequent cardiovascular morbidity and mortality.