Echolucency of carotid plaque is useful for assessment of residual cardiovascular risk in patients with chronic coronary artery disease who achieve LDL-C goals on statin therapy.
BACKGROUND
Ultrasound assessment of either intima-media thickness (IMT) or plaque echolucency of the carotid artery provides prognostic information on coronary events. This study examined the hypothesis that IMT and plaque echolucency of the carotid artery may remain useful for prediction of coronary events in patients with coronary artery disease (CAD) after achievement of LDL-C goals on statin therapy.


RESULTS
Ultrasound assessment of carotid maximum IMT (maxIMT) and plaque echolucency with integrated backscatter (IBS) analysis was performed in 357 chronic CAD patients with LDL-C <100mg/dl on statin therapy. All patients were prospectively followed up until the occurrence of one of the following coronary events: cardiac death, non-fatal myocardial infarction, or unstable angina pectoris requiring unplanned revascularization. During a mean follow-up of 32±18 months, 33 coronary events occurred. On multivariate Cox proportional hazards analysis, plaque echolucency (lower IBS value) was a significant predictor of coronary events (HR, 0.44; 95% CI: 0.29-0.73; P=0.009), whereas maxIMT was not. The addition of plaque echolucency to traditional risk factors improved net reclassification improvement (NRI) and integrated discrimination improvement (IDI; NRI, 0.59; P=0.0013; and IDI, 0.075; P=0.0009).


CONCLUSIONS
Measurement of echolucency of the carotid artery was useful for assessment of residual coronary risk in CAD patients after LDL-C goal attainment on statin treatment.
Department of Internal Medicine II, Yamanashi University Hospital.
Manabu
M
Uematsu
Takamitsu
T
Nakamura
Wataru
W
Sugamata
Yoshinobu
Y
Kitta
Daisuke
D
Fujioka
Yukio
Y
Saito
Ken-Ichi
K
Kawabata
Jun-Ei
JE
Obata
Yosuke
Y
Watanabe
Kazuhiro
K
Watanabe
Kiyotaka
K
Kugiyama
D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D016893:Carotid Stenosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D008078:Cholesterol, LDL / Q000097:blood*; D002908:Chronic Disease; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy; D058226:Plaque, Atherosclerotic / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D012189:Retrospective Studies; D014463:Ultrasonography
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors