Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris

Background Ultrasonographic assessments of intimamedia thickness and plaque s in the carotid artery are widely used as surrogate markers for coronary a therosclerosis, but prospective evaluations are scarce and appear to be lac king in patients with coronary artery disease. Ultrasonographic evaluations of femoral vascular changes have not been studied prospectively. Methods and Results In the Angina Prognosis Study in Stockholm (APSIS), 809 patients with stable angina pectoris were studied prospectively during dou ble-blind treatment with verapamil or metoprolol. Ultrasonographic assessme nts of intima-media thickness, lumen diameter and plaques in the carotid an d femoral arteries were evaluated in a subgroup of 558 patients (182 female s) with a mean age of 60 +/- 7 years, and related to the risk of cardiovasc ular death (n = 18) or non-fatal myocardial infarction (n = 26), or revascu larization (n=70) during follow-up (median 3.0 years). Univariate Cox regre ssion analyses showed that carotid intima-media thickness and plaques were related to the risk of cardiovascular death or myocardial infarction. Femor al intima-media thickness was related to cardiovascular death or myocardial infarction, as well as to revascularization, whereas femoral plaques were only related to the latter. After adjustment for age, sex, smoking,previous cardiovascular disease and lipid status, carotid intima-media thickness fa iled to predict any cardiovascular event, whereas carotid plaques tended (P =0.056) to predict the risk of cardiovascular death or myocardial infarctio n. Femoral intima-media thickness (P<0.01) and plaques (P<0.05) were also r elated to the risk of revascularization after adjustments. Conclusions Carotid and femoral vascular changes were differently related t o cardiovascular events. Carotid intima-media thickness was a weak predicto r of events, whereas femoral intima-media thickness predicted revasculariza tion. Plaques in the carotid artery were related to cardiovascular death or non-fatal myocardial infarction, whereas plaques in the femoral artery wer e related to revascularization. Evaluations of plaques provided better pred iction than assessments of intima-media thickness in patients with stable a ngina. (Eur Heart J 2001; 22: 62-72, doi:10.1053/euhj.1999.2006) (C) 2001 T he European Society of Cardiology.