Plaque Composition in the Proximal Superficial Femoral Artery and Peripheral Artery Disease Events

Mary M. McDermott, Christopher M. Kramer, Lu Tian, James Carr, Jack M. Guralnik, Tamar Polonsky, Timothy Carroll, Melina Kibbe, Michael H. Criqui, Luigi Ferrucci, Lihui Zhao, Daniel S. Hippe, John Wilkins, Dongxiang Xu, Yihua Liao, Walter McCarthy, Chun Yuan

Research output: Contribution to journalArticle

Abstract

Objectives: The aim of this study was to describe associations of the presence of lipid-rich necrotic core (LRNC) in the proximal superficial femoral artery (SFA) with lower extremity peripheral artery disease (PAD) event rates and systemic cardiovascular event rates. Background: LRNC in the coronary and carotid arteries is associated with adverse outcomes but has not been studied previously in lower extremity arteries. Methods: Participants with ankle-brachial index (ABI) values <1.00 were identified from Chicago medical centers and followed annually. Magnetic resonance imaging was used to characterize SFA atherosclerotic plaque at baseline. Medical records for hospitalizations and procedures after baseline were adjudicated for lower extremity revascularization, amputation, and critical limb ischemia and also for new coronary events, ischemic stroke, and mortality. Results: Of 254 participants with PAD, 62 (24%) had LRNC and 149 (59%) had calcium in the SFA at baseline. Cox regression analyses were adjusted for age, sex, race, comorbidities, baseline ABI, and other confounders. SFA LRNC was associated with an increased incidence of the combined outcome of lower extremity amputation, critical limb ischemia, ABI decline >0.15, and revascularization at 47-month follow-up (hazard ratio: 2.18; 95% confidence interval: 1.27 to 3.75; p = 0.005). The association of SFA LRNC with PAD events was maintained even when this combined outcome excluded lower extremity revascularization (hazard ratio: 2.58; 95% confidence interval: 1.25 to 5.33; p = 0.01). LRNC in the SFA was not associated with all-cause mortality, acute coronary events, or stroke. Conclusions: Among patients with PAD, LRNC in the SFA was associated with higher rates of clinical PAD events, and this association was independent of ABI. Further study is needed to determine whether interventions that reduce SFA LRNC prevent PAD events.

Original languageEnglish (US)
JournalJACC: Cardiovascular Imaging
DOIs
StateAccepted/In press - Apr 26 2016
Externally publishedYes

Fingerprint

Peripheral Arterial Disease
Femoral Artery
Lipids
Ankle Brachial Index
Lower Extremity
Confidence Intervals
Carotid Arteries
Coronary Vessels
Arteries
Stroke
Mortality

Keywords

  • Femoral artery
  • Lipid rich necrotic core
  • MRI
  • Vascular medicine

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

McDermott, M. M., Kramer, C. M., Tian, L., Carr, J., Guralnik, J. M., Polonsky, T., ... Yuan, C. (Accepted/In press). Plaque Composition in the Proximal Superficial Femoral Artery and Peripheral Artery Disease Events. JACC: Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2016.08.012

Plaque Composition in the Proximal Superficial Femoral Artery and Peripheral Artery Disease Events. / McDermott, Mary M.; Kramer, Christopher M.; Tian, Lu; Carr, James; Guralnik, Jack M.; Polonsky, Tamar; Carroll, Timothy; Kibbe, Melina; Criqui, Michael H.; Ferrucci, Luigi; Zhao, Lihui; Hippe, Daniel S.; Wilkins, John; Xu, Dongxiang; Liao, Yihua; McCarthy, Walter; Yuan, Chun.

In: JACC: Cardiovascular Imaging, 26.04.2016.

Research output: Contribution to journalArticle

McDermott, MM, Kramer, CM, Tian, L, Carr, J, Guralnik, JM, Polonsky, T, Carroll, T, Kibbe, M, Criqui, MH, Ferrucci, L, Zhao, L, Hippe, DS, Wilkins, J, Xu, D, Liao, Y, McCarthy, W & Yuan, C 2016, 'Plaque Composition in the Proximal Superficial Femoral Artery and Peripheral Artery Disease Events', JACC: Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2016.08.012
McDermott, Mary M. ; Kramer, Christopher M. ; Tian, Lu ; Carr, James ; Guralnik, Jack M. ; Polonsky, Tamar ; Carroll, Timothy ; Kibbe, Melina ; Criqui, Michael H. ; Ferrucci, Luigi ; Zhao, Lihui ; Hippe, Daniel S. ; Wilkins, John ; Xu, Dongxiang ; Liao, Yihua ; McCarthy, Walter ; Yuan, Chun. / Plaque Composition in the Proximal Superficial Femoral Artery and Peripheral Artery Disease Events. In: JACC: Cardiovascular Imaging. 2016.
@article{54a94f19e0fd430d8171cd83372b8ae2,
title = "Plaque Composition in the Proximal Superficial Femoral Artery and Peripheral Artery Disease Events",
abstract = "Objectives: The aim of this study was to describe associations of the presence of lipid-rich necrotic core (LRNC) in the proximal superficial femoral artery (SFA) with lower extremity peripheral artery disease (PAD) event rates and systemic cardiovascular event rates. Background: LRNC in the coronary and carotid arteries is associated with adverse outcomes but has not been studied previously in lower extremity arteries. Methods: Participants with ankle-brachial index (ABI) values <1.00 were identified from Chicago medical centers and followed annually. Magnetic resonance imaging was used to characterize SFA atherosclerotic plaque at baseline. Medical records for hospitalizations and procedures after baseline were adjudicated for lower extremity revascularization, amputation, and critical limb ischemia and also for new coronary events, ischemic stroke, and mortality. Results: Of 254 participants with PAD, 62 (24{\%}) had LRNC and 149 (59{\%}) had calcium in the SFA at baseline. Cox regression analyses were adjusted for age, sex, race, comorbidities, baseline ABI, and other confounders. SFA LRNC was associated with an increased incidence of the combined outcome of lower extremity amputation, critical limb ischemia, ABI decline >0.15, and revascularization at 47-month follow-up (hazard ratio: 2.18; 95{\%} confidence interval: 1.27 to 3.75; p = 0.005). The association of SFA LRNC with PAD events was maintained even when this combined outcome excluded lower extremity revascularization (hazard ratio: 2.58; 95{\%} confidence interval: 1.25 to 5.33; p = 0.01). LRNC in the SFA was not associated with all-cause mortality, acute coronary events, or stroke. Conclusions: Among patients with PAD, LRNC in the SFA was associated with higher rates of clinical PAD events, and this association was independent of ABI. Further study is needed to determine whether interventions that reduce SFA LRNC prevent PAD events.",
keywords = "Femoral artery, Lipid rich necrotic core, MRI, Vascular medicine",
author = "McDermott, {Mary M.} and Kramer, {Christopher M.} and Lu Tian and James Carr and Guralnik, {Jack M.} and Tamar Polonsky and Timothy Carroll and Melina Kibbe and Criqui, {Michael H.} and Luigi Ferrucci and Lihui Zhao and Hippe, {Daniel S.} and John Wilkins and Dongxiang Xu and Yihua Liao and Walter McCarthy and Chun Yuan",
year = "2016",
month = "4",
day = "26",
doi = "10.1016/j.jcmg.2016.08.012",
language = "English (US)",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Plaque Composition in the Proximal Superficial Femoral Artery and Peripheral Artery Disease Events

AU - McDermott, Mary M.

AU - Kramer, Christopher M.

AU - Tian, Lu

AU - Carr, James

AU - Guralnik, Jack M.

AU - Polonsky, Tamar

AU - Carroll, Timothy

AU - Kibbe, Melina

AU - Criqui, Michael H.

AU - Ferrucci, Luigi

AU - Zhao, Lihui

AU - Hippe, Daniel S.

AU - Wilkins, John

AU - Xu, Dongxiang

AU - Liao, Yihua

AU - McCarthy, Walter

AU - Yuan, Chun

PY - 2016/4/26

Y1 - 2016/4/26

N2 - Objectives: The aim of this study was to describe associations of the presence of lipid-rich necrotic core (LRNC) in the proximal superficial femoral artery (SFA) with lower extremity peripheral artery disease (PAD) event rates and systemic cardiovascular event rates. Background: LRNC in the coronary and carotid arteries is associated with adverse outcomes but has not been studied previously in lower extremity arteries. Methods: Participants with ankle-brachial index (ABI) values <1.00 were identified from Chicago medical centers and followed annually. Magnetic resonance imaging was used to characterize SFA atherosclerotic plaque at baseline. Medical records for hospitalizations and procedures after baseline were adjudicated for lower extremity revascularization, amputation, and critical limb ischemia and also for new coronary events, ischemic stroke, and mortality. Results: Of 254 participants with PAD, 62 (24%) had LRNC and 149 (59%) had calcium in the SFA at baseline. Cox regression analyses were adjusted for age, sex, race, comorbidities, baseline ABI, and other confounders. SFA LRNC was associated with an increased incidence of the combined outcome of lower extremity amputation, critical limb ischemia, ABI decline >0.15, and revascularization at 47-month follow-up (hazard ratio: 2.18; 95% confidence interval: 1.27 to 3.75; p = 0.005). The association of SFA LRNC with PAD events was maintained even when this combined outcome excluded lower extremity revascularization (hazard ratio: 2.58; 95% confidence interval: 1.25 to 5.33; p = 0.01). LRNC in the SFA was not associated with all-cause mortality, acute coronary events, or stroke. Conclusions: Among patients with PAD, LRNC in the SFA was associated with higher rates of clinical PAD events, and this association was independent of ABI. Further study is needed to determine whether interventions that reduce SFA LRNC prevent PAD events.

AB - Objectives: The aim of this study was to describe associations of the presence of lipid-rich necrotic core (LRNC) in the proximal superficial femoral artery (SFA) with lower extremity peripheral artery disease (PAD) event rates and systemic cardiovascular event rates. Background: LRNC in the coronary and carotid arteries is associated with adverse outcomes but has not been studied previously in lower extremity arteries. Methods: Participants with ankle-brachial index (ABI) values <1.00 were identified from Chicago medical centers and followed annually. Magnetic resonance imaging was used to characterize SFA atherosclerotic plaque at baseline. Medical records for hospitalizations and procedures after baseline were adjudicated for lower extremity revascularization, amputation, and critical limb ischemia and also for new coronary events, ischemic stroke, and mortality. Results: Of 254 participants with PAD, 62 (24%) had LRNC and 149 (59%) had calcium in the SFA at baseline. Cox regression analyses were adjusted for age, sex, race, comorbidities, baseline ABI, and other confounders. SFA LRNC was associated with an increased incidence of the combined outcome of lower extremity amputation, critical limb ischemia, ABI decline >0.15, and revascularization at 47-month follow-up (hazard ratio: 2.18; 95% confidence interval: 1.27 to 3.75; p = 0.005). The association of SFA LRNC with PAD events was maintained even when this combined outcome excluded lower extremity revascularization (hazard ratio: 2.58; 95% confidence interval: 1.25 to 5.33; p = 0.01). LRNC in the SFA was not associated with all-cause mortality, acute coronary events, or stroke. Conclusions: Among patients with PAD, LRNC in the SFA was associated with higher rates of clinical PAD events, and this association was independent of ABI. Further study is needed to determine whether interventions that reduce SFA LRNC prevent PAD events.

KW - Femoral artery

KW - Lipid rich necrotic core

KW - MRI

KW - Vascular medicine

UR - http://www.scopus.com/inward/record.url?scp=85006284608&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85006284608&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2016.08.012

DO - 10.1016/j.jcmg.2016.08.012

M3 - Article

C2 - 27838307

AN - SCOPUS:85006284608

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

ER -