Composition of Carotid Atherosclerotic Plaque Is Associated With Cardiovascular Outcome: A Prognostic Study

OBJECTIVES: Identification of patients at risk for primary and secondary manifestations of atherosclerotic disease progression is based mainly on established risk factors. The atherosclerotic plaque composition is thought to be an important determinant of acute cardiovascular events, but no prospective studies have been performed. The objective of the present study was to investigate whether atherosclerotic plaque composition is associated with the occurrence of future vascular events.

METHODS: Atherosclerotic carotid lesions were collected from patients who underwent carotid endarterectomy and were subjected to histological examination. Patients underwent clinical follow-up yearly, up to 3 years after carotid endarterectomy. The primary outcome was defined as the composite of a vascular event (vascular death, nonfatal stroke, nonfatal myocardial infarction) and vascular intervention. The cumulative event rate at 1-, 2-, and 3-year follow-up was expressed by Kaplan–Meier estimates, and Cox proportional hazards regression analyses were performed to assess the independence of histological characteristics from general cardiovascular risk factors.

RESULTS: During a mean follow-up of 2.3 years, 196 of 818 patients (24%) reached the primary outcome. Patients whose excised carotid plaque revealed plaque hemorrhage or marked intraplaque vessel formation demonstrated an increased risk of primary outcome (risk difference=30.6% versus 17.2%; hazard ratio [HR] with [95% confidence interval]=1.7 [1.2 to 2.5]; and risk difference=30.0% versus 23.8%; HR=1.4 [1.1 to 1.9], respectively). Macrophage infiltration (HR=1.1 [0.8 to 1.5]), large lipid core (HR=1.1 [0.7 to 1.6]), calcifications (HR=1.1 [0.8 to 1.5]), collagen (HR=0.9 [0.7 to 1.3]), and smooth muscle cell infiltration (HR=1.3 [0.9 to 1.8]) were not associated with clinical outcome. Local plaque hemorrhage and increased intraplaque vessel formation were independently related to clinical outcome and were independent of clinical risk factors and medication use.

CONCLUSIONS: The local atherosclerotic plaque composition in patients undergoing carotid endarterectomy is an independent predictor of futurecardiovascular events. Ricky Seals-Jones Womens Jersey

PMID:

Posted in Computed Tomography, Echo, Invasive Imaging, Magnetic Resonance Imaging and tagged , , , , , , , .

2 Comments

  1. Interesting study based on histology of pathology specimens of the carotid artery, with impact of imaging of “vulnerable plaques”

    The concept is that certain plaque features e.g. in the carotid artery, are a systemic marker of future cardiovascular events.

    Note that plaque hemorrhage, marked intraplaque vessel formation demonstrated an increased risk of primary outcome. However, macrophage infiltration, large lipid core, calcifications, collagen, and smooth muscle cell infiltration were not associated with clinical outcome.

  2. Great data, well analyzed!

    One specific comment that caught my attentions was that the authors start with the premise of identifying the presence of a “vulnerable plaque“. And then, in their discussion they mention that: “The predictive value of plaque hemorrhage and intra-plaque vessel density could enable early identification of the vulnerable patient…” This is the term commonly used by those in the school of thought that don’t believe in identifying the vulnerable plaques, but rather the vulnerable patient in order to intervene.

    So, does finding a plaque with characteristics associated with vulnerability mean that we must deal with a vulnerable patient and forget about that specific single plaque?

    Thoughts?

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