(VP001) 10-YEAR CARDIOVASCULAR EVENTS IN LOW AND INTERMEDIATE RISK PATIENTS SCREENED FOR CAROTID DISEASE IN A COMMUNITY CARDIOLOGY CLINIC

Background: Several methods exist for quantifying plaque burden. Most are not used due to the time-consuming nature of the imaging and measurements. Rotterdam plaque score is simple and quick to perform. Obtainable with 4-6 B-mode images. The Kingston Heart Clinic; a community-based referral cardiology clinic has been collecting carotid imaging data for the past 16 years. The aim of the present study was to determine the clinical predictive usefulness of carotid plaque score, with respect to MACE (CV death + non-fatal stroke + non-fatal myocardial infarction + emergency CABG).

METHODS AND RESULTS: Males 40-70 years and females 40-75 years were selected. Follow up was 1-10 years. Males >70 years and Females >75 years, were excluded as high risk. Patients with a history of previous vascular intervention or MACE were excluded. Kaplan-Meier curves for MACE stratified by plaque score were performed. Administrative data holdings housed at IC/ES were used for event follow-up.

There were 8,472 patients, 5,121 females and 3,351 males. The average age: Females, 58.7 ± 8.4 vs males, 59.7 ± 8.6 (P < 0.0001). Maximal CCA IMT: Females, 0.99 ± 0.41 mm vs males, 1.12 ± 0.49 mm (P < 0.0001). Plaque was present in: Females, 53.9% vs males, 64.0% (P < 0.0001). Males were more likely to smoke (21.7% vs 17.1%, P< 0.0001), be treated for hypertension (45.9% vs 40.8%, P< 0.0001), dyslipidemia (40.0% vs 29.8%, P< 0.0001) and diabetes (15.8% vs 12.3%, P< 0.0001). There were 278 MACE events. The 10-year MACE event rate (Table 1.) was 3.3%, with 13 CV deaths, 93 non-fatal strokes, 136 non-fatal MI and 36 emergency revascularizations. MACE was more common in M, 4.2% vs F, 2.7% (P < 0.0001), due to higher rates of non-fatal myocardial and emergency revascularization. There was no sex difference in CV death or non-fatal stroke. The Kaplan-Meier curve of MACE according to plaque score is seen in figure 1

Conclusion: Plaque scores of 0 or 1 are associated with a low 10-year MACE rate of < 3%. This is similar to the 10-year CV risk of low CT calcium scores (0-99). Increasing plaque score is associated with increasing 10-year MACE risk. Plaque score could be used as a screening examination for assessment of CV risk in otherwise low and intermediate risk patients. Ultrasound equipment for measuring plaque score is both low-cost and more prevalent than CT calcium scoring. We believe this makes risk assessment for vascular disease simple and more accessible.