Common carotid intima-media thickness measurement is not a pertinent predictor for secondary cardiovascular events after coronary bypass surgery. A prospective study

Objective: We aimed to assess the utility of common carotid intima-media thickness (CCA-IMT) to predict secondary cardiovascular events after coronary artery bypass grafting (CABG). In primary prevention, carotid-IMT is known as a valuable cardiovascular risk marker, but its interest in secondary prevention has been less studied. We hypothesized that CCA-IMT could be used for peri-operative and long-term risk stratification in candidates for CABG. Methods: A total of 609 patients (66.8 +/- 9.2 years) were prospectively enrolled for preoperative CCA-IMT measurement and follow-up. The primary end-point combined cardiovascular death, non-fatal acute coronary syndromes, stroke, secondary coronary revascutarization and peripheral arterial surgery during follow-up. The secondary end-point was the 1-month post-operative death. Univariate and multivariate analysis were performed by usual methods. Results: A subgroup of 150 patients (24.6%) was individualized with a CCA-IMT above 90th percentile (> 0.90 mm) or presenting plaques in their CCA. At 1 month, there was no significant difference in the prevalence of elevated CCA-IMT between deceased patients and survivors (16.7vs. 24.9%, P=ns). During a mean follow-up of 41.8+16 months, 121 patients (19.8%) met the primary end-point. High CCA-IMT was predictive (OR-1.67, 95% Cl 1.14-2.46, P=0.009) in the univariate analysis. In the muttivariate analysis, age (OR= 1.03, 95% Cl 1.00-1.05, P=0.029) concomitant valvular surgery (OR=2.17, P=0.003) arrhythmia (OR=2.20, P=0.021), and peripheral arterial disease (OR=2.41, P < 0.001) were significant independent prognostic factors whereas CCA-IMT failed to remain independently significant. Conclusions: Pre-operative CCA-IMT can provide prognostic information for candidates to CABG. However, clinical data present stronger prognostic values. (c) 2005 Elsevier B.V. All rights reserved.