The Prognostic Significance of Carotid Intima-Media Thickness in Patients Who Underwent Percutaneous Coronary Intervention

Taek-Geun Kwon; Ki-Hong Kim; Hyun-Ju Yoon; Dae-Woo Hyun; Jang-Ho Bae

doi:10.4070/kcj.2007.37.3.103

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Kwon, Kim, Yoon, Hyun, and Bae: The Prognostic Significance of Carotid Intima-Media Thickness in Patients Who Underwent Percutaneous Coronary Intervention

Original Article

Korean Circulation J 2007;37(3):103-107.

Published online: 10 December 2007

DOI: https://doi.org/10.4070/kcj.2007.37.3.103

The Prognostic Significance of Carotid Intima-Media Thickness in Patients Who Underwent Percutaneous Coronary Intervention

Taek-Geun Kwon, MD, Ki-Hong Kim, MD, Hyun-Ju Yoon, MD, Dae-Woo Hyun, MD, Jang-Ho Bae, MD

Cardiology Division, Heart Center, Konyang University Hospital, Deajeon, Korea

Correspondence: Jang-Ho Bae, MD, Cardiology Division, Heart Center, Konyang University Hospital, 685 Gasoowon-dong, Seo-gu, Daejeon 302-718, Korea Tel: 82-42-600-9420, Fax: 82-42-600-9400 e-mail: janghobae@yahoo.co.kr

Received 9 January 2007 Accepted 21 February 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives

Increased carotid intima-media thickness (IMT) is known to be associated with adverse cardiovascular events in the patients with risk factors or established atherosclerosis. However, the prognostic importance of carotid IMT is uncertain in the patients who underwent percutaneous coronary intervention (PCI). We sought to evaluate the association of carotid IMT with major adverse cardiovascular events (MACE) and restenosis in the patients who underwent PCI.

Subjects and Methods

The study population consisted of 308 consecutive patients who underwent PCI, and they were followed up for mean of 30.6±13.3 months. Base on the median values of carotid IMT, which was measured in the right common carotid artery at the time of PCI with using high-resolution ultrasound and a semiautomatic method, the subjects were divided into the thick (n=156, 1.003±0.14 mm) and thin IMT (n=152, 0.748±0.07 mm) groups, and they were followed up for at least 1 year.

Results

Patients with thick carotid IMT were older (61±9 years vs. 57±10 years, respectively, p=0.001), had a higher body mass index (25.0±3.0 vs. 23.9±4.0, respectively, p=0.017), a history of previous myocardial infarction (20% vs. 9%, respectively, p=0.008), more multivessel disease and more restenosis (34.6% vs. 23.0%, respectively, p=0.025) than those patients with a thin carotid IMT. However other MACEs such as death, myocardial infarction, stroke, heart failure and target lesion revascularization did not show any significant differences between the two groups. Multivariate Cox regression analysis showed that carotid IMT was an independent predictor of restenosis (odds ratio: 1.754, 95% confidence interval: 1.1296 to 2.726, p=0.012).

Conclusion

An increased carotid IMT is associated with restenosis, but it does not have clinical prognostic importance for the patients who underwent PCI during a mean follow up period of 31 months.

Key Words:

Key Words

Carotid arteres, Angioplasty, transluminal, percutaneous coronary, Prognosis

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Fig. 1.

Kaplan-Meier curves for event-free survival showed that MACEs (cardiac death, acute myocardial infarction, target lesion revascularization and stroke) were not associated with carotid intima-media thickness (Thin IMT group; patients whose carotid IMT≤0.84 mm, Thick IMT group; patients whose carotid IMT>0.84 mm). MACEs: major adverse cardiovascular events, IMT: intima-media thickness.

Fig. 2.

Major adverse cardiovascular events were not different between the thick carotid IMT group (carotid IMT>0.84 mm) and the thin carotid IMT group (carotid IMT≤0.84 mm), except for restenosis.*: p<0.05. AMI: acute myocardial infarction, CHF: congestive heart failure, TLR: target lesion revascularization, IMT: intima-media thickness.

Table 1.

Characteristics of the patients

	Thin carotid IMT (≤0.84 mm, n=152)	Thick carotid IMT (>0.84 mm, n=156)	p
Age (years)	57.5±10.1	61.1±9.11	0.001
Men	198 (65%)	105 (67%)	0.600
BMI (kg/m²)	23.9±4.01	25.0±3.01	0.017
Previous MI	114 (09%)	131 (20%)	0.008
Risk factors
Hypertension	182 (54%)	185 (55%)	0.924
Diabetes mellitus	138 (25%)	152 (33%)	0.108
Dyslipidemia	145 (30%)	151 (33%)	0.533
Smoker, current	151 (34%)	166 (42%)	0.113
Lipid analysis
Total cholesterol (mg/dL)	185±550	185±471	0.992
Triglyceride (mg/dL)	187±119	176±118	0.404
HDL cholesterol (mg/dL)	40.5±10.6	40.4±10.0	0.987
LDL cholesterol (mg/dL)	104±400	108±381	0.390
Carotid IMT (mm)	0.748±0.070	1.003±0.140	<0.001
Diagnosis
Stable angina	181 (53.3%)	187 (55.8%)
Unstable angina	129 (19.1%)	123 (14.7%)
Acute MI	142 (27.6%)	146 (29.5%)
Ejection fraction	61.3±9.71	60.6±10.1	0.538
Angiographic findings
Mutivessel disease	165 (42.8%)	94 (60.3%)	0.003
Angioplasty			0.223
Balloon only	117 (14.6%)	119 (15.8%)
Bare metal stent	126 (82.9%)	117 (75%).1
Drug eluting stent	119 (12.5%)	130 (19.2%)
Medications
ACE inhibitor	187 (57.2%)	192 (59.0%)	0.757
Statins	104 (68.4%)	111 (71.2%)	0.601
Beta-blockers	153 (34.9%)	157 (36.5%)	0.760
Calcium channel blockers	162 (40.8%)	150 (32.3%)	0.121

Values are means± SDs. IMT: intima-media thickness, BMI: body mass index, MI: myocardial infration, ACE: angiotensin converting enzyme, HDL: high density lipoprotein, LDL: low density lipoprotein

Table 2.

Predictors of restenosis by multivariate Cox regression analysis

	Beta	RR	95% CI	p
Age (years)	–0.012	0.988	0.965–1.012	0.327
Male gender	–0.244	1.277	0.787–2.071	0.322
Carotid IMT	–0.562	1.754	1.129–2.726	0.012
Stent
Length	–0.021	0.979	0.943–1.017	0.271
Diameter	–0.005	1.005	0.893–1.132	0.930

IMT: intima-media thickness, RR: relative risk, CI: confidence interval

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