Key result
High carotid plaque score linked to ~188% greater MACE risk and improves stress echo sensitivity.
Why the study?
Stress echocardiography has limitations in predicting MACE, so this study evaluated whether adding a carotid plaque score enhances test diagnostics for predicting MACE in low-intermediate-risk patients.
Does adding a carotid plaque score to stress echocardiography improve the prediction of 5-year major adverse cardiovascular events in low-intermediate-risk patients?
Cohort (n=2,588)
No
Does adding a carotid plaque score to stress echocardiography improve the prediction of 5-year major adverse cardiovascular events in low-intermediate-risk patients?
Integrating a simple carotid plaque score with stress echocardiography significantly improves the sensitivity for predicting 5-year major adverse cardiovascular events, aiding in the risk stratification of patients with non-positive stress echo results.
May support enhanced stratification with stress echocardiography; leaves open prospective validation before practice change.
Aims: Stress echocardiography (SE), though widely accessible, has some limitations in its diagnostic test characteristics for predicting major adverse cardiovascular events (MACEs). Carotid plaque score provides direct detection of subclinical atherosclerosis and can be integrated into the stress protocol. The aim of our study was to assess the value of adding a carotid plaque score to SE to enhance the test diagnostics for predicting MACE in low-intermediate-risk patients. Methods and results: Patients aged 40-75 years referred for SE received a carotid ultrasound and were followed for 5-year MACE. Hard MACE was defined as a composite of cardiovascular death, non-fatal stroke or myocardial infarction, and emergency coronary revascularization. Soft MACE included non-emergency coronary revascularization. Patients aged >75 years, on a statin, with previously known vascular disease, a history of stroke, myocardial infarction, vascular intervention, or a resting wall motion abnormality on a baseline echo were excluded. Administrative data holdings housed at the Institute of Clinical Evaluative Sciences, ICES, were used for event follow-up. Of the 2588 patients, there were 49 cumulative incidence hard MACE and 119 soft MACE. Carotid plaque score improved the sensitivity of SE for predicting 1- and 5-year MACE. A plaque score threshold value of ≥2 provided clear differentiation of patients who experienced MACE in both positive and non-positive (negative/inconclusive for ischaemia) SE results. Conclusion: Plaque score enhances diagnostic test characteristics of SE. The combination of carotid ultrasound with SE is an important new tool for cardiovascular risk assessment. This simple tool may help differentiate risk in patients with non-positive SE results.
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Matangi et al. (2025) conducted a cohort in Low-intermediate cardiovascular risk (n=2,588). Carotid plaque score ≥2 vs. Carotid plaque score 0-1 was evaluated on 5-year hard MACE (composite of cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, and emergency coronary revascularization) (HR 2.88, 95% CI 1.65-5.05, p=0.0002). A carotid plaque score of ≥2 was associated with an increased risk of 5-year hard major adverse cardiovascular events (HR 2.88) and improved the sensitivity of stress echocardiography from 20.0% to 46.7%.
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