Key result
Elevated MMP-9 predicts ~44% higher MACE risk after carotid revascularization, alongside high CAVI and low GSM.
Why the study?
The relationship of novel biomarkers and imaging indices with carotid atherosclerosis severity and MACE after carotid revascularization was not well defined.
Do novel biomarkers and imaging indices (CAVI, MMP-9, GSM) predict MACE in patients with carotid stenosis?
Cohort (n=463)
No
Do novel biomarkers and imaging indices (CAVI, MMP-9, GSM) predict MACE in patients with carotid stenosis?
Hazard Ratio: 1.44 (95% CI 1.29–2.15)
p-value: p=0.005
High CAVI, elevated MMP-9, and low GSM independently predict major adverse cardiovascular events in patients undergoing carotid revascularization, identifying a 'vulnerable patient' phenotype.
CAVI, MMP-9, and low GSM may stratify post-revascularization MACE risk; leaves open whether targeting them alters outcomes.
Background: We investigated the relationship of matrix metalloproteinases (MMPs), cardio-ankle vascular index (CAVI), and Gray-Scale Median (GSM) score with the severity and vulnerability of carotid atherosclerosis and major adverse cardiovascular events (MACE) during follow-up of carotid artery revascularization. Methods: We enrolled 262 patients undergoing carotid revascularization therapy (GRT), 109 asymptomatic patients with low-grade carotid stenosis (40–70%) receiving conservative treatment (GCT), and 92 age- and sex-matched control subjects without carotid atherosclerosis (GCO). All participants underwent carotid ultrasound and we assessed at baseline clinical parameters, metabolic profile, CAVI, GSM, and circulating levels of hsCRP, MMP-3,-7,-9, and TIMP-1. Results: Both GRT and GCT presented with elevated CAVI, MMPs, and TIMP-1 levels compared to GCO (p < 0.001). The escalation highly correlated to the presence of symptoms or paralleled the degree of carotid stenosis (p < 0.001). During follow-up (mean duration: 55 months), 51 GRT patients experienced MACE unrelated to the revascularization procedure. Within GRT, diabetes (HR: 2.07; CI: 1.55–2.78, p < 0.001), smoking (HR: 1.67; CI: 1.35–1.95, p < 0.001), high CAVI (HR: 1.22; CI: 1.09–1.43, p = 0.023) and MMP-9 (HR: 1.44; CI: 1.29–2.15, p = 0.005), and low GSM (HR: 1.40; CI: 1.16–2.12, p = 0.002) independently predicted MACE occurrences, despite the optimum medical therapy. Conclusions: Novel imaging and biochemical biomarkers were positively associated with atherosclerosis severity, while CAVI, MMP-9, and low GSM showed a positive, independent relationship with MACE after carotid revascularization, describing “vulnerable patients”.
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Kadoglou et al. (2023) conducted a cohort in Carotid stenosis (n=463). Elevated MMP-9 was evaluated on Major adverse cardiovascular events (MACE) (HR 1.44, 95% CI 1.29-2.15, p=0.005). Elevated MMP-9 (HR 1.44; 95% CI 1.29-2.15), high CAVI, and low GSM independently predicted major adverse cardiovascular events after carotid revascularization.
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