Key result
Decreasing carotid plaque GSM is linked to ~116% greater cardiovascular risk in ACS patients.
Why the study?
Carotid atherosclerotic plaque echogenicity evaluates cardiovascular risk, but its GSM assessment and prognostic impact in ACS required evaluation.
Does a decrease in the echogenicity of carotid artery atherosclerotic plaques (measured by GSM) predict cardiovascular events in patients with acute coronary syndrome?
Cohort (n=143)
Does a decrease in the echogenicity of carotid artery atherosclerotic plaques (measured by GSM) predict cardiovascular events in patients with acute coronary syndrome?
Relative Risk: 2.16 (95% CI 1.3–3.5)
p-value: p=0.009
A decrease in the echogenicity of carotid artery atherosclerotic plaques over time is associated with an increased risk of subsequent cardiovascular events in patients with acute coronary syndrome.
GSM decline may flag higher-risk ACS patients; leaves open whether serial carotid imaging refines risk stratification.
Some studies have shown that the echogenicity of atherosclerotic plaques (AP) in the carotid arteries (CA) plays an important role in evaluating the risk of cardiovascular events (CVE). The method of calculating the Gray Scale Median (GSM) is currently used to quantify the echogenicity of the CA plaque. Aim. To study GSM assessment of CA AP in patients with acute coronary syndrome (ACS) and the effect of GSM on the prognosis of CVE. Material and methods . We examined 143 patients with ACS (32-83 years old). Duplex scanning was performed on “Philips iU 22” for 1-3 days after hospitalization, the second — in 1-1,5 years. The echogenicity of the detected APs was assessed on a gray scale using a modified GSM method at the Multivox workstation. Results. We analyzed 378 CA AP in patients with ACS. The GSM analysis on the first and repeated surveys showed a significant increase in the average GSM by 2,2% (p<0,05). During follow-up, 23% of patients had various cardiovascular diseases (death, MI, exacerbation of coronary artery disease, repeated coronary artery revascularization, stroke). Results of GSM analysis of patients with and without CVE revealed statistically significant changes: GSM AP decrease in patients with CVE by 7,8% (p<0,05), and an increase in GSM in patients without CVE by 6,1% (p<0,05). ROC analysis showed that a relative decrease in GSM ≥6,96% with a sensitivity of 53,5% and a specificity of 71,1% determines the development of an unfavorable outcome (the area under the curve is 0,628±0,0465; 95% CI 0,55-0,7), p=0,006). The risk of CVE developing increased by 2,16 times with a decrease in GSM dynamics by more than 6,96% (RR 2,16; 95% CI 1,3-3,5; p=0,009). Conclusion. The results of study show the importance of assessing the echogenicity of CA AP in patients with ACS. A decrease in the echogenicity of AP in such patients over time may indicate an increase in the risk of CVE developing and may be the reason to correct the therapy.
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Guchaeva et al. (2019) conducted a cohort in acute coronary syndrome (n=143). Relative decrease in Gray Scale Median (GSM) ≥6.96% vs. Decrease in GSM <6.96% or increase was evaluated on Cardiovascular events (death, MI, exacerbation of coronary artery disease, repeated coronary artery revascularization, stroke) (RR 2.16, 95% CI 1.3-3.5, p=0.009). A relative decrease in carotid plaque echogenicity (GSM) by ≥6.96% over 1-1.5 years was associated with an increased risk of cardiovascular events in ACS patients (RR 2.16; 95% CI 1.3-3.5; p=0.009).
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