The impact of carotid plaque presence and morphology on mortality outcome in cardiological patients

Abstract

Background: Carotid plaque severity and morphology can affect cardiovascular prognosis. We evaluate both the importance of echographically assessed carotid artery plaque geometry and morphology as predictors of death in hospitalised cardiological patients.

Methods: 541 hospitalised patients admitted in a cardiological division (age = 66 +/- 11 years, 411 men), have been studied through ultrasound Duplex carotid scan and successively followed-up for a median of 34 months. Echo evaluation assessed plaque severity and morphology (presence of heterogeneity and profile).

Results: 361 patients showed carotid stenosis (67% with < 50% stenosis, 18% with 50-69% stenosis, 9% with > 70% stenosis, 4% with near occlusion and 2% with total occlusion). During the follow-up period, there were 83 all-cause deaths (15% of the total population). Using Cox's proportional hazard model, age (RR 1.06, 95% CI 1.03-1.09, p = 0.000), ejection fraction > 50% (RR = 0.62, 95% CI 0.4-0.96, p = 0.03), treatment with statins (RR = 0.52, 95% CI 0.29-0.95, p = 0.34) and the presence of a heterogeneous plaque (RR 1.6; 95% CI, 1.2 to 2.14, p = 0.002) were independent predictors of death. Kaplan-Meier survival estimates have shown the best outcome in patients without plaque, intermediate in patients with homogeneous plaques and the worst outcome in patients with heterogeneous plaques (90% vs 79% vs 73%, p = 0.0001).

Conclusion: In hospitalised cardiological patients, carotid plaque presence and morphology assessed by ultrasound are independent predictors of death.

Figure 1

Survival free of event (death) as a function of severity of stenosis. Numbers of patients at risk are listed below each group. Patients without plaque +; < 50% stenosis O; 50–69% stenosis □; ≥ 70% stenosis ◇; near occlusion and occlusion Δ.

Figure 2

Survival free of event (death) as a function of presence of heterogeneous plaque. Numbers at risk are listed below each group.