Work

Association of carotid atherosclerotic disease on ultrasound with functionally relevant coronary artery disease: a prospective cohort study, a subanalysis of BASEL VIII

Year: 2026

Type: article

Abstract: Background: Atherosclerosis is a systemic disease underlying coronary artery disease (CAD), and carotid atherosclerosis may serve as an accessible marker of systemic atherosclerotic burden. However, the diagnostic and prognostic relevance of carotid plaque characteristics in patients with suspected functionally relevant coronary artery disease (fCAD) remains uncertain. We aimed to investigate the association of carotid atherosclerotic plaque burden and morphology with fCAD and to evaluate the prognostic value of carotid plaque characteristics for future cardiovascular events. Methods: This prospective diagnostic subanalysis of the BASEL VIII cohort included 430 consecutive patients evaluated for suspected fCAD at the University Hospital Basel, Switzerland, between October 2011 and February 2016. fCAD was determined by myocardial perfusion imaging using single-photon emission computed tomography, supplemented by coronary angiography and fractional flow reserve measurements when available. Carotid ultrasound and contrast-enhanced ultrasound (CEUS) were performed at enrollment to assess plaque presence, burden, stenosis severity, echogenicity, and intraplaque neovascularization. Diagnostic performance was evaluated using receiver operating characteristic analysis. Major adverse cardiovascular events (MACE), comprising non-fatal myocardial infarction, stroke, and cardiovascular death, were assessed during long-term follow-up using Kaplan-Meier analysis and Cox proportional hazards regression. Results: 68.0%, P=0.02). However, plaque burden, stenosis severity, plaque echogenicity, and intraplaque neovascularization were not significantly associated with fCAD. During 8 years of follow-up, 30 patients (7.0%) experienced non-fatal myocardial infarction, 17 (4.0%) suffered stroke, and 34 (7.9%) died from cardiovascular causes. The presence of carotid atherosclerotic disease was significantly associated with a higher risk of MACE [hazard ratio (HR) 2.69, 95% confidence interval (CI): 1.33-5.45]. This association remained significant after adjustment for cardiovascular risk factors and fCAD (HR 2.14, 95% CI: 1.09-4.42). In contrast, plaque morphology characteristics, including echogenicity and intraplaque neovascularization, did not provide additional diagnostic or prognostic value. Conclusions: The presence of carotid atherosclerotic plaques was associated with fCAD and with an increased risk of future cardiovascular events in patients evaluated for suspected fCAD. However, carotid plaque burden, stenosis severity, echogenicity, and intraplaque neovascularization do not appear to improve the identification of fCAD or the prediction of long-term cardiovascular outcomes. In clinical practice, carotid plaque presence may provide complementary information on systemic atherosclerotic burden, whereas advanced carotid plaque characterization does not appear to add clinically relevant diagnostic or prognostic information in this patient population.

Source: Cardiovascular Diagnosis and Therapy

DOI: 10.21037/cdt-2026-0353