Author + information
- Received October 6, 2016
- Revision received December 7, 2016
- Accepted December 12, 2016
- Published online February 5, 2018.
- Shahram Ahmadvazir, MDa,b,
- Benoy N. Shah, BSc, MBBSa,b,
- Konstantinos Zacharias, MBBSa and
- Roxy Senior, MD, DMa,b,∗ ()
- aDepartment of Cardiovascular Medicine and Institute for Medical Research, Northwick Park Hospital, Harrow, United Kingdom
- bCardiovascular Biomedical Research Unit, Imperial College, London and Royal Brompton Hospital, London, United Kingdom
- ↵∗Address for correspondence:
Prof. Roxy Senior, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
Objectives This study hypothesized that ischemia and atherosclerosis assessment by ultrasound (US) may provide incremental prognostic information in patients with new-onset chest pain who do not have coronary artery disease (CAD).
Background The clinical significance of atherosclerosis assessment by carotid US in patients undergoing stress echocardiography (SE) in such patients is unknown.
Methods Consecutive patients with suspected angina but no history of CAD underwent simultaneous SE and US prospectively to assess myocardial ischemia and carotid plaque burden (CPB), respectively. Patients were followed up for major adverse events (MAEs)—all-cause mortality, nonfatal myocardial infarction, and unplanned coronary revascularization.
Results Of 591 recruited patients, 580 (men, 46%; mean age 59 ± 11 years) patients were available for follow-up. SE demonstrated myocardial ischemia in 12%, but prevalence of carotid plaques was 59%. During a mean follow-up of 1,117 ± 361 days, 40 first MAEs occurred. In the multivariable regression model, pre-test probability (PTP) of CAD (p = 0.001), abnormal SE (p < 0.0001), and CPB (p < 0.0001) predicted MAEs. MAE rates per year increased from 0.9% versus 1.97% versus 4.3% versus 9.7% in patients with no carotid plaque and normal SE versus patients who had plaque and normal SE versus those with no plaque and abnormal SE versus patients with plaque and abnormal SE, respectively (p < 0.0001). In hierarchical analysis, plaque burden provided incremental prognostic value over PTP of CAD and SE; likewise, SE was incremental to PTP-CAD and CPB (p < 0.0001 for both).
Conclusions In patients with suspected stable angina without known CAD, simultaneous SE (for ischemia) and US (for atherosclerosis) provided incremental prognostic value.
Prof. Senior has received speaker fees/honorarium from Bracco and Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 6, 2016.
- Revision received December 7, 2016.
- Accepted December 12, 2016.
- 2018 American College of Cardiology Foundation