Carotid Plaque Parameters and Nonculprit Coronary Lesion Plaque Progression After PCI

Carotid plaque length and intraplaque neovascularization (IPN) score are highly correlated with nonculprit coronary lesion plaque progression after percutaneous coronary intervention (PCI), researchers reported in the International Journal of Cardiology.

The retrospective, cross-sectional study assessed the association between carotid plaque parameters detected on carotid ultrasound and contrast-enhanced ultrasound, as well as coronary artery plaque progression in nonculprit lesions.

Participants aged 18 to 80 years who had previously received PCI were enrolled in the study from September 2020 to April 2022. All patients were receiving moderate-intensity statins. A total of 173 patients were categorized into 2 groups based on coronary angiography results at baseline and follow-up: the progression group (n=55) and the nonprogression group (n=118).

Binary logistic regression multivariate analysis was used to assess the association between carotid plaque parameters detected on ultrasound and contrast-enhanced ultrasound and nonculprit coronary lesions plaque progression.

The participants had a mean age of 60.36±8.42 years, and 80.35% were men. Nonculprit coronary lesion plaque progression was observed in 31.79% of patients and 143 patients had carotid plaques.

No statistically significant difference was observed in intima–media thickness between the 2 groups (t=1.436; P =.162), and the difference in plaque echogenicity also was not statistically significant (χ² = 0.084, P =.772). Plaque thickness, plaque length, and IPN score in the progressive group were significantly increased compared with those in the nonprogressive group (P <.01).

Multivariate analysis demonstrated that a history of previous PCI (odds ratio [OR], 3.995; 95% CI, 1.241-12.865), plaque length (OR, 3.418, 95% CI, 1.101-10.610), and IPN score (OR, 7.395; 95% CI, 3.154-17.342) were strongly associated with plaque progression in nonculprit coronary lesions. A history of previous PCI, plaque length, and IPN score remained independent predictors for plaque progression in nonculprit coronary lesions after adjustment for age, high-density lipoprotein cholesterol, C-reactive protein, serum creatinine, and plaque thickness (P <.05).

The logistic regression model’s specificity, negative predictive value, accuracy, positive predictive value, and sensitivity for predicting nonculprit coronary lesion progression were 90.53%, 82.69%, 81.12%, 76.92%, and 62.50%, respectively, with an area under the receiver operating characteristic curve of 0.882 (95% CI, 0.826-0.939).

Plaque thickness, length, and IPN score were significantly (P <.01) greater in the progressive group vs the nonprogressive group within 1 year and longer than 3 years. The difference in plaque thickness was not statistically significant (P >.05) in the 2 groups between 12 and 36 months, and the differences between plaque length and IPN score were statistically significant (P < .05).

Limitations of the study include the single-center, retrospective, cross-sectional, observational design and small sample size. Although all patients received statins, the investigators did not obtain the length of time or whether participants had received other lipid-lowering medications. In addition, the relationship between statin therapy and carotid plaque parameters was not evaluated, and the researchers did not assess the association between carotid plaque parameters and cardiovascular events separately.

“This present study demonstrates that carotid plaque length and IPN score measured by ultrasound and contrast-enhanced ultrasound were strongly correlated with the plaque progression of nontarget coronary lesions,” the investigators wrote. “The combination of plaque length, IPN score, and the history of previous PCI has good predictive value in predicting the plaque progression of nontarget coronary lesions.”