Progression of carotid stenosis detected by duplex ultrasonography predicts adverse outcomes in cardiovascular high-risk patients.
OBJECTIVE
The progression of carotid stenosis reflects the activity of atherosclerotic disease and may indicate a risk for systemic atherothrombotic complications. We investigated whether progressive carotid stenosis determined by duplex ultrasonography predicts adverse outcomes in cardiovascular high-risk patients.


METHODS
We prospectively studied 1065 of 1268 consecutive patients initially asymptomatic with respect to carotid disease. Carotid ultrasound investigations at baseline and after a median of 7.5 months (range, 6 to 9 months) were performed to identify patients with progressive stenosis as defined by Doppler velocity criteria. Patients were then followed up clinically for a median of 3.2 years for the occurrence of major adverse cardiovascular events (composite MACEs: myocardial infarction, percutaneous coronary or peripheral interventions, coronary or vascular surgery, amputation, stroke, and all-cause mortality).


RESULTS
We found progressive carotid stenosis in 93 patients (9%) by ultrasound and thereafter recorded 495 MACEs in 421 patients (40%) during clinical follow-up. Patients with progressive carotid stenosis had a significantly increased risk for cardiovascular events compared with patients with nonprogressive disease: adjusted hazard ratios and confidence intervals were 2.01 for composite MACEs (95% CI, 1.48 to 2.67, P<0.001), 2.38 for myocardial infarction (95% CI, 1.07 to 5.35, P=0.044), 1.59 for any coronary event (95% CI, 1.10 to 2.28, P=0.011), 2.00 for stroke (95% CI, 1.02 to 4.11, P=0.035), 2.42 for any peripheral vascular event (95% CI, 1.61 to 3.62, P<0.001), and 1.75 for cardiovascular death (95% CI, 1.03 to 2.97, P=0.039).


CONCLUSIONS
Progression of carotid stenosis within a 6- to 9-month interval detected by duplex ultrasound predicts midterm clinical adverse events of atherosclerosis in high-risk patients affecting the coronary, cerebrovascular, and peripheral circulations.
Sabeti
Schila
S
Department of Angiology, Medical University Vienna, Vienna, Austria.
Schlager
Oliver
O
Exner
Markus
M
Mlekusch
Wolfgang
W
Amighi
Jasmin
J
Dick
Petra
P
Maurer
Gerald
G
Huber
Kurt
K
Koppensteiner
Renate
R
Wagner
Oswald
O
Minar
Erich
E
Schillinger
Martin
M
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D002545:Brain Ischemia / Q000401:mortality; D002318:Cardiovascular Diseases / Q000401:mortality*; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000401:mortality; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D015996:Survival Rate; D018616:Ultrasonography, Doppler, Duplex / Q000592:standards; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data