Inserm, U970, Paris Cardiovascular Research Centre, PARCC, University Paris Descartes, UMR-S970, Paris, France.
Atherosclerosis. 2011 Dec;219(2):917-24. doi: 10.1016/j.atherosclerosis.2011.09.024. Epub 2011 Sep 28.
We sought to address the respective association between carotid intima-media thickness (IMT) in plaque-free sites and plaques with coronary heart disease (CHD) and their usefulness for CHD risk prediction in the Three-City Study.
At baseline, 5895 CHD-free adults aged 65-85 years underwent a bilateral ultrasound examination of carotid arteries. Mean IMT was measured in the far wall of the right and left common carotid arteries (CCA) at plaque-free site while the presence of focal plaques was assessed in the near and the far walls of the CCAs, the bifurcations and the origin of the internal carotid arteries.
After a median follow-up of 5.4 years, 223 subjects had a first ever CHD event. In multivariate analysis, carotid plaques were independent predictors of CHD (Hazard ratio (HR)(plaques at 1 site) = 1.5; 95% confidence interval (CI) = 1.0-2.2; HR(plaques at ≥ 2 sites) = 2.2; 95% CI = 1.6-3.1; p(for trend) < 0.001), contrary to mean CCA-IMT (HR(fifth vs.first quintile) = 0.8; 95% CI = 0.5-1.2; p(for trend) < 0.48). Adding carotid plaques to conventional risk factors significantly improved CHD risk prediction as measured by the area under the ROC curve (from 0.728 to 0.745; p = 0.04), the Harrell's c (from 0.748 to 0.762; p < 0.001), and the integrated discrimination improvement (IDI = 0.007; p = 0.002)/net reclassification improvement (NRI = 13.7%; p < 0.001) indices.
Carotid plaques, but not CCA-IMT measured at a plaque-free site, were independent predictors of CHD and improved CHD risk prediction in older adults.
我们旨在探讨颈动脉无斑块部位内膜中层厚度（IMT）与斑块和冠心病（CHD）的相关性，及其在三城市研究中对 CHD 风险预测的作用。
在基线时，年龄在 65-85 岁之间的 5895 名无 CHD 的成年人接受了双侧颈动脉超声检查。在无斑块部位的右侧和左侧颈总动脉（CCA）的远壁测量平均 IMT，同时评估 CCA 的近壁和远壁、分叉处和颈内动脉起始处是否存在局灶性斑块。
在中位随访 5.4 年后，223 名受试者发生首次 CHD 事件。多变量分析显示，颈动脉斑块是 CHD 的独立预测因素（斑块 1 处的 HR（比值比）= 1.5；95%置信区间（CI）= 1.0-2.2；斑块≥2 处的 HR = 2.2；95%CI = 1.6-3.1；p（趋势）<0.001），而 CCA-IMT 则不然（第 5 五分位与第 1 五分位的 HR = 0.8；95%CI = 0.5-1.2；p（趋势）<0.48）。将颈动脉斑块加入传统危险因素后，CHD 风险预测的曲线下面积（从 0.728 增加到 0.745；p = 0.04）、哈雷尔 C 指数（从 0.748 增加到 0.762；p<0.001）、综合判别改善（IDI = 0.007；p = 0.002）/净重新分类改善（NRI = 13.7%；p<0.001）均显著提高。
颈动脉斑块，而非无斑块部位的 CCA-IMT，是 CHD 的独立预测因素，并改善了老年人 CHD 风险预测。
