BACKGROUND While the impact of carotid plaque on cardiovascular events is well investigated in asymptomatic epidemiologic studies, the long-term clinical impact of carotid plaque and its burden (CPB) in patients with new-onset suspected stable angina with no history of coronary artery disease beyond stress echocardiography (SE) is not known. We sought to investigate this with a prospective study, where patients were followed up for adverse events. METHODS Consecutive patients referred for SE underwent simultaneous carotid ultrasonography to assess CPB, defined as the total number of carotid plaques per patient. Stress echocardiography was reported off-line using a 17-segments model and four-point wall thickening scoring. Peak wall thickening scoring index was the sum of scores of each segment divided by 17. RESULTS Of the 592 patients, 573 (age 59 ± 11, 45% male) had follow-up data. During a mean of 7.2 years, 85 patients had a first major adverse event (all-cause mortality and acute myocardial infarction: 68 had hard events and 17 had unplanned revascularization). On multivariate Cox regression analysis, pretest probability of coronary artery disease (P = .048), peak wall thickening scoring index (P < .0001), and CPB (P < .0001) predicted major adverse events; however, only CPB retained significance for both hard events and hard cardiac events (P = .001 and < .0001, respectively). Major adverse events and hard events were the least in patients with normal SE and absent carotid plaque (annualized event rate: 1.1% and 1.02%, respectively), with a significant increase in normal SE and carotid plaque disease (2.4% and 2.05%, P = .004 and P = .01, respectively). The presence of plaque did not have an impact on these outcomes in an abnormal SE cohort. CONCLUSIONS In patients with suspected stable angina with no history of cardiovascular disease, carotid atherosclerosis and myocardial ischemia detected by ultrasound provided synergistic information for the long-term prediction of events, but atherosclerosis predicted hard events beyond myocardial ischemia, particularly in patients with a normal SE.

中文翻译：

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疑似心绞痛患者同时评估动脉粥样硬化和缺血的长期预后价值：在负荷超声心动图期间常规使用颈动脉超声的意义。

背景 虽然颈动脉斑块对心血管事件的影响在无症状流行病学研究中得到了很好的研究，但颈动脉斑块及其负担 (CPB) 对新发疑似稳定型心绞痛患者的长期临床影响及其负担 (CPB)负荷超声心动图 (SE) 未知。我们试图通过一项前瞻性研究对此进行调查，对患者的不良事件进行随访。方法连续接受 SE 转诊的患者接受同步颈动脉超声检查以评估 CPB，定义为每位患者的颈动脉斑块总数。使用 17 节段模型和四点壁增厚评分离线报告应力超声心动图。峰壁增厚评分指数为各节段评分总和除以17。 结果 592例患者中，573 人（59 ± 11 岁，45% 男性）有随访数据。在平均 7.2 年的时间里，85 名患者发生了第一次主要不良事件（全因死亡率和急性心肌梗死：68 名发生严重事件，17 名发生意外血运重建）。在多变量 Cox 回归分析中，冠状动脉疾病的预测概率 (P = .048)、峰值壁增厚评分指数 (P < .0001) 和 CPB (P < .0001) 可预测主要不良事件；然而，只有 CPB 对硬事件和硬心脏事件均保持显着性（分别为 P = .001 和 < .0001）。有正常 SE 和无颈动脉斑块的患者的主要不良事件和硬事件最少（年化事件率：分别为 1.1% 和 1.02%），正常 SE 和颈动脉斑块疾病显着增加（2.4% 和 2.05%，分别为 P = .004 和 P = .01）。在异常 SE 队列中，斑块的存在对这些结果没有影响。结论 在没有心血管疾病史的疑似稳定型心绞痛患者中，超声检测到的颈动脉粥样硬化和心肌缺血为事件的长期预测提供了协同信息，但动脉粥样硬化可以预测心肌缺血以外的硬事件，特别是在 SE 正常的患者中.