Multiterritory Atherosclerosis and Carotid Intima-Media Thickness as Cardiovascular Risk Predictors After Percutaneous Angioplasty of Symptomatic Subclavian Artery Stenosis
| Autor: | Agnieszka Rosławiecka, Piotr Pieniazek, Izabela Karch, Krzysztof Zmudka, Szymon Mleczko, Tadeusz Przewłocki, Leszek Wrotniak, Anna Kabłak-Ziembicka, Lukasz Tekieli |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Comorbidity 030204 cardiovascular system & hematology Carotid Intima-Media Thickness Coronary artery disease 03 medical and health sciences Subclavian Steal Syndrome 0302 clinical medicine Risk Factors Internal medicine medicine.artery Angioplasty medicine Humans Carotid Stenosis Radiology Nuclear Medicine and imaging 030212 general & internal medicine Myocardial infarction Aged Aged 80 and over Radiological and Ultrasound Technology business.industry Middle Aged Atherosclerosis medicine.disease Stenosis Intima-media thickness Cardiovascular Diseases cardiovascular system Cardiology Female Poland Internal carotid artery business Subclavian steal syndrome |
| Zdroj: | Journal of Ultrasound in Medicine. 35:1977-1984 |
| ISSN: | 0278-4297 |
| DOI: | 10.7863/ultra.15.10042 |
| Popis: | Objectives To identify independent predictors of cardiovascular events among patients with subclavian artery stenosis. Methods Two hundred eighteen consecutive patients with subclavian artery stenosis referred to angioplasty were examined for coexistent coronary, renal, or lower extremity artery stenosis of 50% or greater. Initial carotid intima-media thickness and internal carotid artery (ICA) stenosis were assessed. Intima-media thickness was reassessed in 108 randomly chosen patients to evaluate the change over time. The incidence of cardiovascular death, myocardial infarction (MI), ischemic stroke, and symptomatic lesion progression was recorded. Results The patients included 116 men and 102 women (mean age ± SD, 62.1 ± 8.4 years). Isolated subclavian artery stenosis and involvement of 1, 2, and 3 or 4 other territories with stenosis of 50% or greater were found in 46 (21.1%), 83 (38.1%), 55 (25.2%), and 34 (15.6%) patients, respectively. Internal carotid artery stenosis of 50% or greater (relative risk [RR], 1.54; 95% confidence interval [CI], 1.39–1.70; P < .001) and initial intima-media thickness (RR, 1.16; 95% CI, 1.05–1.28; P = .005) were identified as independent markers of multiterritory atherosclerosis. The optimal intima-media thickness cutoff for atherosclerosis extent was 1.3 mm (sensitivity, 75.6%; specificity, 76.1%). During follow-up of 57 ± 35 months, cardiovascular death, MI, and ischemic stroke occurred in 29 patients (13.3%). Those patients had significantly higher intima-media thickness progression (+0.199 ± 0.57 versus +0.008 ± 0.26 mm; P = .039) and more widespread initial atherosclerosis (mean territories, 1.8 ± 1.1 versus 1.3 ± 1.1; P = .042). Independent predictors of cardiovascular death, MI, ischemic stroke, and lesion progression were coronary artery disease (RR, 1.32; 95% CI, 1.10–1.58; P = .003) and intima-media thickness progression (RR, 1.22; 95% CI, 1.02–1.46; P = .033; sensitivity, 75.0%; specificity, 61.8%). Conclusions In patients with symptomatic subclavian artery stenosis, baseline carotid intima-media thickness and ICA stenosis of 50% or greater are associated with multiterritory atherosclerosis, whereas intima-media thickness progression is associated with the risk of cardiovascular events. |
| Databáze: | OpenAIRE |
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