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Canadian Journal of Cardiology

Common Carotid Intima-Media Thickness as a Risk Factor for Outcomes in Asian Patients With Acute ST-Elevation Myocardial Infarction

      Abstract

      Background

      Carotid intima-media thickness (CIMT) is associated with an increased risk of cardiovascular disease. We studied whether CIMT predicts the prognosis of Asian patients with acute ST-elevation myocardial infarction (STEMI).

      Methods

      A total of 345 patients with STEMI (men, 82.9%; age, 59 ± 13 years) treated with emergent revascularization were prospectively investigated. In all patients, common CIMT was measured with high-resolution ultrasonography. The patients were followed for a median period of 583 days, and the primary end point was major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, heart failure, nonfatal recurrent MI, revascularization, and stroke.

      Results

      Mean CIMT of the patients with STEMI was 0.77 ± 0.14 mm. Of the total patients, 20.6% had carotid plaque and 11.0% experienced MACE. Killip class, left ventricular (LV) function, and carotid plaque were associated with 30-day MACE, whereas CIMT and carotid plaque were related to overall MACE. After adjusting for age, the event rate was 19.0% in the third-tertile CIMT (≥ 0.83 mm) group, 12.1% in the second-tertile (0.70-0.82 mm) group, and 4.3% in the first-tertile (≤ 0.69 mm) group (P = 0.01). Carotid plaque was independently associated with a higher incidence of MACE (adjusted odds ratio [OR], 3.7; 95% confidence interval [CI], 1.327-10.234; P = 0.012). Area under the receiver operating characteristic (ROC) curve for CIMT tertile (0.69 ± 0.05) was significantly larger compared with those for door-to-balloon time (0.55 ± 0.05), LV ejection fraction (LVEF) (0.49 ± 0.05), and Killip class (0.48 ± 0.05) (P < 0.001).

      Conclusions

      CIMT was a useful prognosticator to predict future cardiovascular events (CVEs) in Asian patients with STEMI.

      Résumé

      Introduction

      L’épaisseur de l’intima-média de la carotide (EIMC) est associée à une augmentation du risque de maladie cardiovasculaire. Nous avons étudié si l’EIMC prédit le pronostic des patients asiatiques souffrant d’un infarctus du myocarde (IM) avec sus-décalage du segment ST.

      Méthodes

      Un total de 345 patients souffrant d’IM avec sus-décalage du segment ST (hommes, 82,9 %; âge, 59 ± 13 ans) traités par une revascularisation émergente ont été évalués de manière prospective. Chez tous les patients, l’EIMC commune a été mesurée par l’échographie haute résolution. Les patients ont été suivis durant une période médiane de 583 jours. Le critère de jugement principal était un critère combiné associant la mortalité cardiovasculaire, l’insuffisance cardiaque, la récurrence d’IM non fatal, la revascularisation et l’accident vasculaire cérébral, soit des événements cardiovasculaires indésirables majeurs (ECIM).

      Résultats

      L’EIMC moyenne des patients souffrant d’IM avec sus-décalage du segment ST était de 0,77 ± 0,14 mm. Dans l’ensemble des patients, 20,6 % avaient de la plaque carotidienne et 11,0 % subissaient des ÉCIM. La classification de Killip, la fonction du ventricule gauche (VG), et la plaque carotidienne étaient associes à des ECIM dans les 30 jours, tandis que l’EIMC et la plaque carotidienne étaient liées à l’ensemble des ECIM. Après l’ajustement selon l’âge, le taux d’événements était de 19,0 % dans le groupe appartenant au troisième tertile d’EIMC (≥ 0,83 mm), de 12,1 % dans le groupe appartenant au deuxième tertile (0,70-0,82 mm) et de 4,3 % dans le groupe appartenant au premier tertile (≤ 0,69 mm) (P = 0,01). La plaque carotidienne était indépendamment associée à une plus grande incidence des ECIM (ratio d’incidence approché ajusté [RIA], 3,7; intervalle de confiance [IC] à 95 %, 1,327-10,234; P = 0,012). La surface sous la courbe caractéristique d’efficacité du récepteur (ROC : receiver operating characteristic) du tertile d’EIMC (0,69 ± 0,05) était significativement plus grande par rapport à celles du temps de prise en d'arrivée à l'urgence jusqu'au gonflement du ballon (0,55 ± 0,05), de la fraction d’éjection du VG (FEVG) (0,49 ± 0,05) et de la classification de Killip (0,48 ± 0,05) (P < 0,001).

      Conclusions

      L’EIMC était un facteur pronostique utile pour prédire les événements cardiovasculaires (ECV) subséquents des patients asiatiques souffrant d’IM avec sus-décalage du segment ST.
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