title: Intima media thickness of the common carotid artery in vascular surgery patients: a predictor of postoperative cardiovascular events.
abstract: BACKGROUND
  Cardiovascular (CV) complications are the leading cause of morbidity and mortality in vascular surgery patients. The Revised Cardiac Risk (RCR) index, identifying cardiac risk factors, is commonly used for preoperative risk stratification. However, a more direct marker of the underlying atherosclerotic disease, such as the common carotid artery intimamedia thickness (CCA-IMT) may be of predictive value as well. The current study evaluated the prognostic value of the CCA-IMT for postoperative CV outcome.
  
  
  METHODS
  In 508 vascular surgery patients, the CCA-IMT was measured using high-resolution B-mode ultrasonography. We recorded the RCR factors: ischemic heart disease, heart failure, cerebrovascular disease, diabetes mellitus, and renal dysfunction. Repeated Troponin T measurements and electrocardiograms were performed postoperatively. The study end point was the composite of 30-day CV events and long-term CV mortality. Multivariable regression analyses were used to assess the additional value of CCA-IMT for the prediction of cardiac events.
  
  
  RESULTS
  In total, 30-day events and long-term cardiovascular mortality were noted in 122 (24%) and 81 (16%) patients, respectively. The optimal predictive value of CCA-IMT, using receiver-operating characteristic curve analysis, for the prediction of CV events was calculated to be 1.25 mm (sensitivity 70%, specificity 80%). An increased CCA-IMT was independently associated with 30-day CV events (OR 2.20, 95% CI 1.38-3.52) and long-term CV mortality (HR 6.88, 95% CI 4.11-11.50), respectively.
  
  
  CONCLUSIONS
  This study shows that an increased CCA-IMT has prognostic value in vascular surgery patients to predict 30-day CV events and long-term CV mortality, incremental to the RCR index.
authors.affiliation: Department of Anesthesiology, Erasmus Medical Center, Rotterdam 3015 GE, The Netherlands.
authors.forename: Willem-Jan
authors.initials: WJ
authors.lastname: Flu
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: van Kuijk
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Ruud
authors.initials: R
authors.lastname: Kuiper
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Dustin
authors.initials: D
authors.lastname: Goei
authors.forename: Tamara
authors.initials: T
authors.lastname: Winkel
authors.forename: Yvette R B M
authors.initials: YR
authors.lastname: van Gestel
authors.forename: Hence J M
authors.initials: HJ
authors.lastname: Verhagen
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000473:pathology; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000601:surgery; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000473:pathology; D017536:Carotid Artery, Common / Q000473:pathology*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D020107:Troponin T / Q000097:blood; D017540:Tunica Media / Q000473:pathology*; D014656:Vascular Surgical Procedures
chemical_list: D020107:Troponin T