Echolucent carotid plaques predict future coronary events in patients with coronary artery disease.
Level 3 - non-randomized controlled study
Prospective observational cohort study evaluating a prognostic marker over a 30-month follow-up.
PubMed 15063426 · doi:10.1016/j.jacc.2003.09.063
What was done
Carotid plaque echogenicity was evaluated via ultrasound with integrated backscatter (IBS) in 286 consecutive coronary artery disease (CAD) patients, comprising 71 patients with acute coronary syndrome (ACS) and 215 with clinically stable CAD. In the stable CAD subgroup, coronary plaque complexity was assessed by angiography, and patients were followed longitudinally for 30 months (or until an event) to track future coronary complications.
What was found
Calibrated IBS values for carotid plaques were significantly lower in ACS patients compared with stable CAD patients (p < 0.01). In stable CAD patients, echolucent carotid plaques predicted the presence of angiographically complex coronary plaques with 83% predictive power. Over 30 months of follow-up, patients with echolucent carotid plaques had a significantly higher incidence of coronary events (Kaplan-Meier p < 0.001), remaining an independent predictor after multivariable adjustment (odds ratio 7.0, 95% CI 2.3 to 21.4; p < 0.001).
Why it matters
This study shows that non-invasive carotid ultrasound tissue characterization can act as a window into systemic plaque instability, providing prognostic risk stratification for future coronary events in stable CAD.
Limits
The longitudinal follow-up was restricted to a single cohort of 215 stable CAD patients, yielding wide confidence intervals around the risk estimate. The abstract does not report the absolute number of events or specific clinical endpoints observed.
Cited by
- context The Honda study utilized optical character recognition on carotid ultrasound images and showed that people with little to no soft plaque have very low rates of heart attack and stroke events.