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Intima media thickness of the common carotid artery in vascular surgery patients: a predictor of postoperative cardiovascular events.
Am Heart J. 2009 Aug; 158(2):202-8.AH

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+Show Affiliations

Department of Anesthesiology, Erasmus Medical Center, Rotterdam 3015 GE, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19619695

Citation

Flu, Willem-Jan, et al. "Intima Media Thickness of the Common Carotid Artery in Vascular Surgery Patients: a Predictor of Postoperative Cardiovascular Events." American Heart Journal, vol. 158, no. 2, 2009, pp. 202-8.
Flu WJ, van Kuijk JP, Hoeks SE, et al. Intima media thickness of the common carotid artery in vascular surgery patients: a predictor of postoperative cardiovascular events. Am Heart J. 2009;158(2):202-8.
Flu, W. J., van Kuijk, J. P., Hoeks, S. E., Kuiper, R., Schouten, O., Goei, D., Winkel, T., van Gestel, Y. R., Verhagen, H. J., Bax, J. J., & Poldermans, D. (2009). Intima media thickness of the common carotid artery in vascular surgery patients: a predictor of postoperative cardiovascular events. American Heart Journal, 158(2), 202-8. https://doi.org/10.1016/j.ahj.2009.05.028
Flu WJ, et al. Intima Media Thickness of the Common Carotid Artery in Vascular Surgery Patients: a Predictor of Postoperative Cardiovascular Events. Am Heart J. 2009;158(2):202-8. PubMed PMID: 19619695.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intima media thickness of the common carotid artery in vascular surgery patients: a predictor of postoperative cardiovascular events. AU - Flu,Willem-Jan, AU - van Kuijk,Jan-Peter, AU - Hoeks,Sanne E, AU - Kuiper,Ruud, AU - Schouten,Olaf, AU - Goei,Dustin, AU - Winkel,Tamara, AU - van Gestel,Yvette R B M, AU - Verhagen,Hence J M, AU - Bax,Jeroen J, AU - Poldermans,Don, PY - 2009/03/31/received PY - 2009/05/27/accepted PY - 2009/7/22/entrez PY - 2009/7/22/pubmed PY - 2009/8/22/medline SP - 202 EP - 8 JF - American heart journal JO - Am Heart J VL - 158 IS - 2 N2 - 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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19619695/Intima_media_thickness_of_the_common_carotid_artery_in_vascular_surgery_patients:_a_predictor_of_postoperative_cardiovascular_events_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00438-4 DB - PRIME DP - Unbound Medicine ER -