Akosah Kwame O, McHugh Vicki L, Barnhart Sharon I, Mathiason Michelle A, Schaper Ana M, Perlock Patricia A
University of Virginia, Division of Cardiovascular Medicine, Charlottesville, Virginia, USA.
Am J Hypertens. 2007 Nov;20(11):1183-8. doi: 10.1016/j.amjhyper.2007.07.007.
Limitations of current models for risk stratification are known. Noninvasive imaging is being advocated as an adjunct to improve risk prediction; however, studies documenting outcomes are rare. Therefore, we aimed to evaluate the negative and positive predictive values of carotid atherosclerosis for future cardiovascular events.
The Early Detection by Ultrasound of Carotid Artery intima media Thickness Evaluation (EDUCATE) study prospectively enrolled 253 consecutive young to middle-aged adults undergoing elective coronary angiography. Bilateral carotid ultrasound and lipid profiles were performed. Carotid atherosclerosis was defined as intima media thickness >/=1.0 mm in the main body, or focal plaque within the body, bulb, or proximal branch. Future events included major (death, myocardial infarction, stroke) and minor (revascularization and new onset heart failure).
Of the enrolled patients 236 completed all tests; mean age was 51 +/- 8 years; 58% women. Sensitivity, specificity, and negative predictive values for carotid atherosclerosis in predicting severe coronary artery disease were 72%, 49% and 79%, with an odds ratio (OR) of 2.2 (95% confidence interval [CI] 1.2-4.0). Of patients suffering major events, 90% had carotid atherosclerosis. Only 1 of 95 without carotid atherosclerosis experienced a major event. Kaplan-Meier analysis revealed differences in event-free survival in favor of subjects without carotid atherosclerosis for major (P = .051) and any event (P = .015). Cox analysis revealed a hazard ratio (HR) of 2.7 (95% CI 1.2-6.2; P = .020) for predicting future events. The relationship remained significant after adjusting for traditional risk factors (HR 2.5, 95% CI 1.1-5.9; P = .034).
Carotid atherosclerosis is associated with severe coronary artery disease and future events. Negative carotid ultrasound is associated with excellent prognosis.
目前风险分层模型的局限性是已知的。无创成像被提倡作为改善风险预测的辅助手段；然而，记录其结果的研究很少。因此，我们旨在评估颈动脉粥样硬化对未来心血管事件的阴性和阳性预测价值。
颈动脉内膜中层厚度超声早期检测评估（EDUCATE）研究前瞻性纳入了253名连续接受选择性冠状动脉造影的中青年成年人。进行了双侧颈动脉超声检查和血脂检测。颈动脉粥样硬化定义为主体内膜中层厚度≥1.0mm，或主体、球部或近端分支内有局灶性斑块。未来事件包括主要事件（死亡、心肌梗死、中风）和次要事件（血管重建和新发心力衰竭）。
在纳入的患者中，236名完成了所有检测；平均年龄为51±8岁；58%为女性。颈动脉粥样硬化预测严重冠状动脉疾病的敏感性、特异性和阴性预测值分别为72%、49%和79%，优势比（OR）为2.2（95%置信区间[CI]1.2 - 4.0）。在发生主要事件的患者中，90%有颈动脉粥样硬化。在95名无颈动脉粥样硬化的患者中，只有1人发生了主要事件。Kaplan-Meier分析显示，无颈动脉粥样硬化的受试者在主要事件（P = 0.051）和任何事件（P = 0.015）方面的无事件生存率存在差异。Cox分析显示，预测未来事件的风险比（HR）为2.7（95%CI 1.2 - 6.2；P = 0.020）。在调整传统风险因素后，这种关系仍然显著（HR 2.5，95%CI 1.1 - 5.9；P = 0.034）。
颈动脉粥样硬化与严重冠状动脉疾病和未来事件相关。颈动脉超声检查结果为阴性与良好的预后相关。
