Assessing Cardiovascular Risk with Coronary Artery Calcium and Carotid Intima-Media Thickness in Patients with Negative Stress Echocardiography

TL;DR

This study shows that patients with negative stress echocardiography but high carotid intima-media thickness or coronary artery calcium scores are at higher risk for cardiovascular events.

Contribution

The study introduces the use of cIMT and CAC scores as predictive tools for cardiovascular outcomes in patients with negative stress echocardiography.

Findings

Patients with increased cIMT and CAC scores had significantly higher rates of cardiovascular events.

CAC scores were strongly associated with increased risk of primary cardiovascular outcomes.

The study highlights the importance of monitoring patients with negative TSE but abnormal cIMT or CAC scores.

Abstract

Background: The role of treadmill stress echocardiography (TSE) in symptomatic patients may be limited. We evaluated whether carotid intima-media thickness (cIMT) and coronary artery calcium (CAC) scores can predict cardiovascular (CV) outcomes in patients with negative TSE. Methods: Patients who had negative TSE and measured cIMT or CAC scoring were enrolled and followed up. The primary CV outcome was defined as a composite of acute coronary syndrome, coronary revascularization, heart failure, stroke, and CV death. Results: Overall, 1095 patients participated. The median follow-up duration was 5.8 years. Patients with increased cIMT and CAC scores experienced a high incidence of primary CV outcomes (normal vs. increased group on cIMT and CAC scoring: 4.4% vs. 20.0% and 0.4% vs. 25.0%, respectively, p < 0.001). In the Cox proportional hazard model, increased cIMT and CAC scores were associated with increased primary CV outcomes (adjusted hazard ratio [95% confidence interval], p-value for increased cIMT and increased CAC scores = 2.939 [1.241–6.960], p = 0.014 and 45.192 [5.497–371.505], p < 0.001, respectively). Conclusions: Patients with increased cIMT and CAC scores have poor CV outcomes even though they have negative TSE results, and therefore, they should be carefully monitored.

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