Increased carotid intima-media thickness predicts cardiovascular events in aortic coarctation

Background: Adult post-coarctectomy patients (CoA) demonstrate increased cardiovascular morbidity and mortality. The carotid intima-media thickness (CIMT), a marker for atherosclerosis, is increased in CoA. The aim was to evaluate the predictive value of CIMT for cardiovascular events. Methods and results: Consecutive CoA patients were prospectively studied during 10.1 +/- 0.7 years follow-up. At baseline and follow-up echocardiography, MRI imaging and CIMT imaging were performed, while cardiovascular events were registered. CIMT data were compared with controls. The composite endpoint included: myocardial infarction, cerebrovascular events (CVAs), and (sudden) cardiac death. 160 CoA patients were studied (median age 31.7 (18-74 years), 64% male). Events occurred in 11 patients (7%), five (3%) with myocardial infarction, four (2.5%) with an ischemic CVA and two (1%) died suddenly. An increased CIMT (>= 0.8 mm) (HR = 15.44, P = <0.001) was predictive for the occurrence of cardiovascular events. Baseline CIMT was increased in CoA compared to controls (0.64 +/- 0.12 mm vs 0.57 +/- 0.07 mm, P = 0.005). CIMT progression rates were similar (0.0091 +/- 0.016 mm/year vs 0.0097 +/- 0.018 mm/year, P = 0.84). Signs of atherosclerosis occurred significantly earlier in CoA patients. Conclusion: The contemporary cardiovascular event rate in CoA is 11% in 10 years. Atherosclerosis seems to appear earlier in CoA patients as compared to controls. CoA patients with a CIMT exceeding 0.8 mm have a fifteen fold higher cardiovascular risk. CIMT seems to be a useful tool for cardiovascular risk assessment in CoA. (C) 2014 Elsevier Ireland Ltd. All rights reserved.