P-006 - CAROTID ARTERY REACTIVITY TO PREDICT CARDIOVASCULAR EVENTS IN PATIENTS WITH AN ABDOMINAL AORTIC ANEURYSM

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Vermeulen J.J. (Department of Surgery, Rijnstate ~ Arnhem ~ Netherlands) , Holewijn S. (Department of Surgery, Rijnstate ~ Arnhem ~ Netherlands) , Reijnen M.M. (Department of Surgery, Rijnstate ~ Arnhem ~ Netherlands) , Thijssen D.H. (Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre ~ Nijmegen ~ Netherlands)
Introduction:
The SMART risk score calculates the risk to develop major cardiovascular events (MACE) in cardiovascular disease patients. The efficacy of this tool for abdominal aortic aneurysm (AAA) patients is limited, while these patients often develop MACE. MACE is linked to vascular health, which can be measured with the carotid artery reactivity (CAR)-test and arterial stiffness measurements. This study explored the predictive capacity of the CAR-test and arterial stiffness for the occurrence of MACE in AAA patients compared to the SMART risk score.
Methods:
A total of 167 patients under surveillance for AAA were included. All underwent the CAR-test to assess carotid artery diameter changes to sympathetic stimulation. Arterial stiffness was measured using the SphygmoCor device. Follow-up data up until one year after study start was collected including aneurysm progression and MACE. MACE was defined as acute coronary syndrome, instable angina pectoris, de novo atrial fibrillation, hospitalization for heart failure, mitral valve insufficiency, revascularization (including PCI and CABG), as well as cardiovascular and non-cardiovascular death. Pearson correlation coefficients were determined between all measurement outcomes and MACE. Multivariate regression analysis was performed to compare three models predicting MACE; 1) SMART score, 2) SMART score and CAR-test and 3) SMART score and arterial stiffness, described with pulse wave velocity (PWV).
Results:
This interim analysis had a median follow-up of 53 [34-90] weeks. Seventeen patients (10.2%) experienced ≥1 MACE and seven patients (4.2%) died. Patients who developed MACE (MACE+) had a significantly higher SMART risk score (60.1 ± 20.4% vs 42.5 ± 19.9%, p=0.007) and more frequently a cardiac history at baseline (82.4% vs 49.3%, p=0.010) compared to patients who did not develop MACE (MACE-, n=143). No significant differences were found for CAR-test (MACE+ 0.95 ± 6.2% vs MACE- 2.13 ± 3.76%, p=0.509), PWV (MACE+ 14.69 ± 6.86 m/s vs MACE- 12.22 ± 5.55 m/s, p=0.229) and augmentation index (MACE+ 31.54 ± 6.58% vs MACE- 29.49 ± 8.86%, p=0.140). Where SMART risk score showed a significant correlation with MACE (r=0.251, p=0.002), CAR-test (r=-0.035, p=0.659), PWV (r=0.101, p=0.210) and AIx (r=0.090, p=0.249) did not show a correlation with MACE. Multivariate analysis also demonstrated SMART risk score to be a significant predictor in all models (model 1: OR 1.38, 95% CI 1.012-1.065). The CAR-test (model 2: OR 1.006, 95% CI 0.868-1.167), and arterial stiffness (model 3: OR 1.028, 95% CI 0.950-1.113) did not have additive value on top of SMART risk score to predict MACE.
Conclusion:
Preliminary data demonstrate a significant correlation between SMART risk score and MACE but not with the CAR-test or arterial stiffness in AAA patients. The CAR-test and arterial stiffness measurements did not show additive value on top of the SMART risk score in this interim analysis. Although not significant, patients with MACE demonstrated a trend towards an attenuated carotid artery response and slightly increased arterial stiffness. Completion of this study should determine whether and to what extent these parameters are predictors for MACE in AAA patients.