(VP007) ADDITION OF A SCREENING CAROTID EXAMINATION TO STRESS ECHO IMPROVES 5-YEAR CARDIOVASCULAR EVENT PREDICTION IN PATIENTS PRESENTING WITH CHEST PAIN OR DYSPNEA

Background: There are no publications on the impact of a carotid screen in patients referred for exercise or pharmacological stress ECHO. Rotterdam plaque score is quick to perform with 4-6 B-mode images. We screened the carotid in patients referred for exercise or Dobutamine stress ECHO. The objective: to determine the predictability of plaque score, when added to stress ECHO with respect to MACE (CV death + non-fatal stroke + non-fatal MI + emergency revascularization).

METHODS AND RESULTS: Males 40-70 years and females 40-75 years undergoing stress ECHO with a screening carotid examination were selected. Follow-up was 1-5 years. M >70 years and F >75 years were excluded as high-risk. P with a history of previous vascular intervention or MACE were excluded. P with a resting wall motion abnormality on baseline ECHO were also excluded. A normal stress ECHO indicated target heart rate had been achieved or exceeded, and there were no inducible ECG or wall motion abnormalities. An abnormal exercise ECHO meant there were inducible wall motion abnormalities following exercise, with or without ECG changes. Kaplan-Meier curves for MACE stratified by stress ECHO result and plaque score were performed. Administrative data holdings housed at IC/ES were used for event follow-up.

There were 2,588 patients; 1,953 female and 635 male. The average age: Female; 58.3 ± 8.7 vs male 56.7 ± 8.0 (P < 0.0001). Maximal CCA IMT: Female; 0.92 ± 0.29 mm vs male; 1.07 ± 0.45 mm (P < 0.0001). Plaque was present in 46.2% of females and 61.9% of males (P < 0.0001). Males were more likely to smoke (23.9% vs 18.0%, P< 0.0001), be treated for; hypertension (46.5% vs 36.7%, P< 0.0001), dyslipidemia (41.7% vs 26.8%, P< 0.0001) and diabetes (19.7% vs 12.0%, P< 0.0001). The 5-year MACE rates are seen in the table. There were 49 events, event rate 1.9%. MACE was more common in males; 3.3% vs females; 1.4% (P=0.0026), primarily due to rates of non-fatal MI. The outcome according to the stress ECHO and carotid findings are seen in the KM curve.

Conclusion: Plaque scores of 0 or 1, irrespective of the stress ECHO result have a low 5-year MACE. A normal stress ECHO, irrespective of the carotid findings also has a low 5-year MACE. Patients with an abnormal stress ECHO and plaque score of 2-6 have increased 5-year MACE and require coronary angiography. Plaque score should be performed with stress ECHO and be added to the report of formal carotid examinations.