Elsevier

International Journal of Cardiology

Volume 377, 15 April 2023, Pages 115-122
International Journal of Cardiology

Association with carotid plaque parameters detected on contrast-enhanced ultrasound and coronary artery plaque progression in non-culprit lesions: A retrospective study

https://doi.org/10.1016/j.ijcard.2023.01.059Get rights and content

Highlights

  • The plaque thickness, length, and IPN score were significantly higher in the progressive group than in the non-progressive group (P < 0.01).

  • The plaque length (OR = 3.418, 95% CI =1.101–10.610) and IPN score (OR = 7.395, 95% CI =3.154–17.342) were strongly associated with plaque progression in NCCLs.

  • The sensitivity, specificity, accuracy, positive and negative predictive value of the logistic regression model in predicting the NCCLs progression were 62.50%, 90.53%, 81.12%, 76.92%, and 82.69%, respectively, and the area under the ROC curve was 0.882 (95% CI: 0.826–0.939).

Abstract

Aim

To investigate the correlation between carotid plaque parameters detected on contrast-enhanced ultrasound(CEUS) and the plaque progression in non-culprit coronary lesions (NCCLs) after percutaneous coronary intervention (PCI).

Methods

In this retrospective cross-sectional study, we analyzed 173 patients who underwent PCI. Patients were stratified into two groups (progression and non-progression groups) by comparing the coronary angiography (CAG) results at baseline and follow-up. The correlation between carotid plaque parameters and plaque progression in NCCLs was analyzed by multivariate logistic regression analysis. A logistic regression model was established to predict NCCLs progression.

Results

Overall, 55 of 173 patients exhibited NCCLs progression (31.79%). Univariate comparisons showed that plaque thickness, plaque length, and IPN score were significantly higher in the progressive group than in the non-progressive group (P < 0.01). Multivariate logistic regression analysis revealed that carotid plaque length (OR = 3.418, 95% CI =1.101–10.610) and IPN score (OR = 7.395, 95% CI =3.154–17.342) were strongly associated with plaque progression in NCCLs. After adjusting for confounders, the history of previous PCI, plaque length, and IPN score were independent predictors of the NCCLs progression (P < 0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the logistic regression model in predicting the NCCLs progression were 62.50%, 90.53%, 81.12%, 76.92%, and 82.69%, respectively, and the area under the receiver operating characteristic (ROC) curve was 0.882 (95% CI: 0.826–0.939).

Conclusions

Carotid plaque length and IPN score were strongly correlated with plaque progression in NCCLs. Combining the history of previous PCI can reasonably predict the NCCLs progression.

Introduction

Coronary heart disease (CHD) has become the leading cause of premature death worldwide [1,2]. With the improvement of living standards, the acceleration of the pace of life, and the increase of life pressure, the incidence of CHD in China is increasing year by year. Percutaneous coronary intervention (PCI) is an effective and commonly used modality for treating CHD [3]. More and more patients with CHD are benefiting from the drug-eluting stents. However, current clinical evidence suggests that adverse cardiovascular events can still occur even with successful PCI [3]. Previous studies have mainly attributed the reason to the culprit lesions [4]. Still, there is increasing evidence that the plaque progression in non-culprit coronary lesions (NCCLs) are associated with cardiovascular events in patients undergoing PCI [5,6]. Clinical studies have found that up to 12.4% of adverse cardiovascular events in the first year after PCI were due to non-target lesions, and the rate increased by 6.3% annually in the following four years [7]. Thus, it is crucial to evaluate and prevent the plaque progression in NCCLs after PCI. Optical coherence tomography (OCT), coronary computed tomography angiography (CCTA), or coronary angiography (CAG) are commonly recommended to evaluate NCCLs [8,9]. Still, they all have limitations, such as invasive, expensive, radiation risk, and potential renal injury. Therefore, it is necessary to find an appropriate non-invasive method to evaluate the plaque progression in NCCLs.

Plaque progression in NCCLs is associated with multiple factors, but the detailed mechanism remains unclear [10]. Some studies have reported that plaque progression in NCCLs is closely related to atherosclerosis [10]. Atherosclerosis is a diffuse systemic disease. The carotid artery and coronary artery are the two most common systems of atherosclerosis. These two arterial systems have similar characteristics and mechanisms in forming atherosclerotic plaques [[11], [12], [13]]. Previous studies have demonstrated the correlation between carotid plaque parameters and cardiovascular events [14,15]. However, to our knowledge, no previous study has explored the relationship between carotid atherosclerosis and plaque progression in NCCLs. Carotid ultrasound(US) is a non-invasive and sensitive screening method for detecting and identifying clinical atherosclerosis [16]. Contrast-enhanced ultrasound (CEUS) can show neovascularization within atherosclerotic plaques very well [17,18]. Therefore, this study aimed to investigate the correlation between the carotid plaque parameters detected on US and CEUS and coronary artery plaque progression in non-culprit lesions.

Section snippets

Materials and methods

The Ethics Committee of our hospital approved this retrospective cross-sectional study and written informed consent was obtained from each subject before enrollment.

Demographics and clinical characteristics of the patients

Of the 173 patients, the mean age was 60.36 ± 8.42 years and 80.35% were male. NCCLs plaque progression was observed in 55(31.79%) of 173 patients. Among the patients with NCCLs progression, there were 29(52.73%) cases of mild to moderate stenosis, 16(29.09%) cases of mild to severe stenosis (Fig. 2), and 10(18.18%) cases of moderate to severe stenosis. Among them, 12(21.82%) patients had plaque progression in multiple non-target vessels. Finally, a total of 67 vessels showed plaque

Discussion

Our study was the first to explore the association between carotid plaque parameters and NCCLs plaque progression after PCI. Multivariate logistic regression analysis showed that plaque length and IPN score correlated highly with NCCLs plaque progression and were independent predictors for plaque progression in NCCLs. Comparison stratified by time after PCI showed that plaque length and IPN score were higher in the progressive group than in the non-progressive group at every post-procedure

Conclusion

This present study demonstrates that carotid plaque length and IPN score measured by ultrasound and contrast-enhanced ultrasound was strongly correlated with the plaque progression of non-target coronary lesions. The combination of plaque length, IPN score and the history of previous PCI has good predictive value in predicting the plaque progression of non-target coronary lesions.

CRediT authorship contribution statement

Ling Ren: Conceptualization, Methodology, Software, Data curation, Writing – original draft. Yanyan Han: Conceptualization, Methodology, Software, Data curation, Writing – original draft. Mei Long: Visualization, Investigation. Lin Yan: Software, Validation. Qi Wang: Visualization, Investigation. Xiang Fei: Supervision. Yukun Luo: Supervision, Writing – review & editing.

Declaration of Competing Interest

The authors of this article declare no competing financial interests exist.

Acknowledgements

None.

References (38)

  • J.F. Polak et al.

    Carotid artery plaque and progression of coronary artery calcium: the multi-ethnic study of atherosclerosis

    J. Am. Soc. Echocardiogr.

    (May 2013)
  • E.J. Benjamin et al.

    Heart disease and stroke statistics-2019 update: a report from the American Heart Association

    Circulation

    (Mar 5 2019)
  • G.W. Stone et al.

    Five-year outcomes after PCI or CABG for left main coronary disease

    N. Engl. J. Med.

    (Nov 7 2019)
  • D.E. Cutlip et al.

    Beyond restenosis: five-year clinical outcomes from second-generation coronary stent trials

    Circulation

    (Sep 7 2004)
  • R.A. Montone et al.

    Management of non-culprit coronary plaques in patients with acute coronary syndrome

    Eur. Heart J.

    (Oct 1 2020)
  • B.C. Zhang et al.

    Qualitative and quantitative evaluation of dynamic changes in non-culprit coronary atherosclerotic lesion morphology: a longitudinal OCT study

    Euro Intervent.

    (Apr 6 2018)
  • T. Sekimoto et al.

    Small dense low-density lipoprotein cholesterol: a residual risk for rapid progression of non-culprit coronary lesion in patients with acute coronary syndrome

    J. Atheroscler. Thromb.

    (Nov 1 2021)
  • L. Cui et al.

    Carotid intraplaque neovascularisation as a predictive factor for future vascular events in patients with mild and moderate carotid stenosis: an observational prospective study

    Ther. Adv. Neurol. Disord.

    (2021)
  • J.F. Polak et al.

    The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease: the multi-ethnic study of atherosclerosis

    J. Am. Heart Assoc.

    (Apr 8 2013)
  • 1

    Ling Ren and Yanyan Han contributed equally to this work.

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