Key result
Carotid plaque presence is linked to ~2.1-fold higher 8-year MACE risk.
Why the study?
Carotid atherosclerosis is an accessible marker of systemic atherosclerotic burden, but the diagnostic and prognostic relevance of carotid plaque characteristics in patients with suspected functionally relevant coronary artery disease (fCAD) remained uncertain.
Does carotid ultrasound and contrast-enhanced ultrasound assessment of plaque presence and morphology improve the identification of functionally relevant coronary artery disease and prediction of major adverse cardiovascular events in patients with suspected functionally relevant coronary artery disease?
Cohort (n=430)
No
Does carotid ultrasound and contrast-enhanced ultrasound assessment of plaque presence and morphology improve the identification of functionally relevant coronary artery disease and prediction of major adverse cardiovascular events in patients with suspected functionally relevant coronary artery disease?
In patients evaluated for suspected functionally relevant coronary artery disease, the simple presence of carotid atherosclerotic plaques on ultrasound is associated with functionally relevant CAD and independently predicts long-term major adverse cardiovascular events, whereas advanced plaque morphology characterization via contrast-enhanced ultrasound adds no diagnostic or prognostic value.
Does not support routine carotid ultrasound in suspected CAD; leaves open its role in refining MACE risk prediction.
Background: Atherosclerosis is a systemic disease underlying coronary artery disease (CAD), and carotid atherosclerosis may serve as an accessible marker of systemic atherosclerotic burden. However, the diagnostic and prognostic relevance of carotid plaque characteristics in patients with suspected functionally relevant coronary artery disease (fCAD) remains uncertain. We aimed to investigate the association of carotid atherosclerotic plaque burden and morphology with fCAD and to evaluate the prognostic value of carotid plaque characteristics for future cardiovascular events. Methods: This prospective diagnostic subanalysis of the BASEL VIII cohort included 430 consecutive patients evaluated for suspected fCAD at the University Hospital Basel, Switzerland, between October 2011 and February 2016. fCAD was determined by myocardial perfusion imaging using single-photon emission computed tomography, supplemented by coronary angiography and fractional flow reserve measurements when available. Carotid ultrasound and contrast-enhanced ultrasound (CEUS) were performed at enrollment to assess plaque presence, burden, stenosis severity, echogenicity, and intraplaque neovascularization. Diagnostic performance was evaluated using receiver operating characteristic analysis. Major adverse cardiovascular events (MACE), comprising non-fatal myocardial infarction, stroke, and cardiovascular death, were assessed during long-term follow-up using Kaplan-Meier analysis and Cox proportional hazards regression. Results: The study included 430 patients with suspected fCAD, of whom 105 (24.4%) were women. fCAD was confirmed in 136 patients (31.6%). Patients with fCAD more frequently exhibited carotid plaques than those without fCAD (78.7% vs. 68.0%, P=0.02). However, plaque burden, stenosis severity, plaque echogenicity, and intraplaque neovascularization were not significantly associated with fCAD. During 8 years of follow-up, 30 patients (7.0%) experienced non-fatal myocardial infarction, 17 (4.0%) suffered stroke, and 34 (7.9%) died from cardiovascular causes. The presence of carotid atherosclerotic disease was independently associated with a higher risk of MACE in both univariable [hazard ratio (HR) 2.69, 95% confidence interval (CI): 1.33–5.45]. This association remained significant after adjustment for cardiovascular risk factors and fCAD (HR 2.14, 95% CI: 1.09–4.42). In contrast, plaque morphology characteristics, including echogenicity and intraplaque neovascularization, did not provide additional diagnostic or prognostic value. Conclusions: The presence of carotid atherosclerotic plaques was associated with fCAD and with an increased risk of future cardiovascular events in patients evaluated for suspected fCAD. However, carotid plaque burden, stenosis severity, echogenicity, and intraplaque neovascularization do not appear to improve the identification of fCAD or the prediction of long-term cardiovascular outcomes. In clinical practice, carotid plaque presence may provide complementary information on systemic atherosclerotic burden, whereas advanced carotid plaque characterization does not appear to add clinically relevant diagnostic or prognostic information in this patient population.
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Isayeva et al. (2026) conducted a cohort in Suspected functionally relevant coronary artery disease (fCAD) (n=430). Carotid atherosclerotic plaque presence and morphology on ultrasound and CEUS vs. Absence of carotid atherosclerotic plaques was evaluated on Major adverse cardiovascular events (MACE: non-fatal myocardial infarction, stroke, and cardiovascular death) (HR 2.14, 95% CI 1.09-4.42). Carotid atherosclerotic plaque presence was associated with functionally relevant CAD (78.7% vs 68.0%, P=0.02) and independently predicted 8-year MACE (adjusted HR 2.14, 95% CI 1.09-4.42).
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