Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
Atherosclerosis. 2012 Jan;220(1):128-33. doi: 10.1016/j.atherosclerosis.2011.06.044. Epub 2011 Jun 30.
We conducted the meta-analysis to compare the diagnostic accuracies of carotid plaque and carotid intima-media thickness (CIMT) measured by B-mode ultrasonography for the prediction of coronary artery disease (CAD) events.
Two reviewers independently searched electronic databases to identify relevant studies through April 2011. Both population-based longitudinal studies with the outcome measure of myocardial infarction (MI) events and diagnostic cohort studies for the detection of CAD were identified and analyzed separately. Weighted summary receiver-operating characteristic (SROC) plots, with pertinent areas under the curves (AUCs), were constructed using the Moses-Shapiro-Littenberg model. Meta-regression analyses, using parameters of relative diagnostic odds ratio (DOR), were conducted to compare the diagnostic performance after adjusting other study-specific covariates.
The meta-analysis of 11 population-based studies (54,336 patients) showed that carotid plaque, compared with CIMT, had a significantly higher diagnostic accuracy for the prediction of future MI events (AUC 0.64 vs. 0.61, relative DOR 1.35; 95%CI 1.1-1.82, p=0.04). The 10-year event rates of MI after negative results were lower with carotid plaque (4.0%; 95% CI 3.6-4.7%) than with CIMT (4.7%; 95% CI 4.2-5.5%). The meta-analysis of 27 diagnostic cohort studies (4.878 patients) also showed a higher, but non-significant, diagnostic accuracy of carotid plaque compared with CIMT for the detection of CAD (AUC 0.76 vs. 0.74, p=0.21 for relative DOR).
The present meta-analysis showed that the ultrasound assessment of carotid plaque, compared with that of CIMT, had a higher diagnostic accuracy for the prediction of future CAD events.
我们进行了荟萃分析，以比较 B 型超声测量颈动脉斑块和颈动脉内膜中层厚度（CIMT）对冠心病（CAD）事件预测的诊断准确性。
两位审查员独立搜索电子数据库，以确定截至 2011 年 4 月的相关研究。分别对以心肌梗死（MI）事件为结局的基于人群的纵向研究和以检测 CAD 为目的的诊断队列研究进行了识别和分析。使用 Moses-Shapiro-Littenberg 模型构建加权综合接收者操作特征（SROC）图，并绘制相关曲线下面积（AUC）。使用相对诊断比值比（DOR）的参数进行荟萃回归分析，以调整其他特定于研究的协变量后比较诊断性能。
对 11 项基于人群的研究（54336 例患者）的荟萃分析表明，与 CIMT 相比，颈动脉斑块对预测未来 MI 事件的诊断准确性更高（AUC 0.64 对 0.61，相对 DOR 1.35；95%CI 1.1-1.82，p=0.04）。阴性结果后 MI 的 10 年事件发生率较低，颈动脉斑块为 4.0%（95%CI 3.6-4.7%），而 CIMT 为 4.7%（95%CI 4.2-5.5%）。对 27 项诊断队列研究（4878 例患者）的荟萃分析也显示，颈动脉斑块对 CAD 的检测诊断准确性高于 CIMT，但差异无统计学意义（AUC 0.76 对 0.74，p=0.21 用于相对 DOR）。
本荟萃分析表明，与 CIMT 相比，超声评估颈动脉斑块对预测未来 CAD 事件具有更高的诊断准确性。
