Carotid plaque score is associated with 10-year major adverse cardiovascular events in low-intermediate risk patients referred to a general cardiology community clinic

Abstract

Aims: Atherosclerotic carotid plaque assessments have not been integrated into routine clinical practice due to the time-consuming nature of both imaging and measurements. Plaque score, Rotterdam method, is simple, quick, and only requires 4-6 B-mode ultrasound images. The aim was to assess the benefit of plaque score in a community cardiology clinic to identify patients at risk for major adverse cardiovascular events (MACE).

Methods and results: Patients ≥ 40 years presenting for risk assessment were given a carotid ultrasound. Exclusions included a history of vascular disease or MACE and being >75 years. Kaplan-Meier curves and hazard ratios were performed. The left and right common carotid artery (CCA), bulb, and internal carotid artery were given 1 point per segment if plaque was present (plaque scores 0-6). Administrative data holdings at ICES were used for 10-year event follow-up. Of 8472 patients, 60% were females (n = 5121). Plaque was more prevalent in males (64% vs. 53.9%; P < 0.0001). The 10-year MACE cumulative incidence estimate was 6.37% with 276 events (males 6.9% vs. females 6.0%; P = 0.004). Having both maximal CCA intima media thickness < 1.00 mm and plaque score = 0 was associated with less events. A plaque score < 2 was associated with a low 10-year event rate (4.1%) compared with 2-4 (8.7%) and 5-6 (20%).

Conclusion: A plaque score ≥ 2 can re-stratify low-intermediate risk patients to a higher risk for events. Plaque score may be used as a quick assessment in a cardiology office to guide treatment management of patients.

Keywords: carotid; major adverse cardiovascular events; plaque score; ultrasound.