冠状动脉钙化、内膜中层厚度和踝臂指数是互补的中风预测指标。
Coronary artery calcification, intima-media thickness, and ankle-brachial index are complementary stroke predictors.
作者信息
Gronewold Janine, Bauer Marcus, Lehmann Nils, Mahabadi Amir A, Kälsch Hagen, Weimar Christian, Berger Klaus, Moebus Susanne, Jöckel Karl-Heinz, Erbel Raimund, Hermann Dirk M
机构信息
From the Departments of Neurology (J.G., C.W., D.M.H.) and Cardiology (M.B., A.A.M., H.K., R.E.), University Hospital Essen, Essen, Germany; Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany (N.L., S.M., K.-H.J.); and Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany (K.B.).
出版信息
Stroke. 2014 Sep;45(9):2702-9. doi: 10.1161/STROKEAHA.114.005626. Epub 2014 Aug 12.
BACKGROUND AND PURPOSE
Coronary artery calcification (CAC), a marker of coronary atherosclerosis, predicts stroke in addition to established risk factors. Whether CAC's predictive value can be improved by peripheral atherosclerosis markers, namely carotid intima-media thickness (CIMT) and ankle-brachial index (ABI), was unknown.
METHODS
A total of 3289 participants of the population-based Heinz Nixdorf Recall study (45-75 years; 48.8% men) without previous stroke or coronary heart disease were evaluated for incident stroke for 9.0±1.9 years. CAC, CIMT, and ABI were examined as stroke predictors.
RESULTS
Eighty-four strokes occurred during follow-up. In multivariable Cox proportional hazard regressions, CAC (hazard ratio, 1.45 [95% confidence interval, 1.11-1.88] per SD increase in ln(CAC+1); SD, 2.40), CIMT (1.34 [1.08-1.66] per SD increase; SD, 0.127 mm), and ABI (1.55 [1.32-1.82] per SD decrease; SD, 0.148) were associated with stroke in addition to established risk factors. When combined with each other, ln(CAC+1)'s hazard ratio remained similar when CIMT (1.41 [1.09-1.83]) was inserted into the multivariable model, but slightly decreased when ABI (1.31 [1.01-1.72]) or CIMT and ABI (1.29 [0.99-1.68]) were included. Although CAC alone did not significantly elevate the area under the curve in Harrell's c-statistics (by 0.009; P=0.379) in addition to established risk factors, the combination of CAC and ABI increased area under the curve (by 0.029; P=0.047), as did ABI (by 0.025; P=0.038) but not CIMT (by 0.002; P=0.795) alone. The combination of CAC and ABI also resulted in significant category-free net reclassification and integrated discrimination improvement.
CONCLUSIONS
CAC, CIMT, and ABI provide complementary information about stroke risk. ABI, which is distinctive in a small subpopulation, had the highest and CIMT, which is distributed across a larger range of values, had the lowest predictive value.
背景与目的
冠状动脉钙化（CAC）是冠状动脉粥样硬化的一个标志物，除了已确定的风险因素外，还可预测中风。外周动脉粥样硬化标志物，即颈动脉内膜中层厚度（CIMT）和踝臂指数（ABI）是否能提高CAC的预测价值尚不清楚。
方法
对基于人群的海因茨·尼克斯多夫召回研究中的3289名参与者（45 - 75岁；48.8%为男性）进行了评估，这些参与者既往无中风或冠心病，随访9.0±1.9年以观察中风发病情况。将CAC、CIMT和ABI作为中风预测指标进行检测。
结果
随访期间发生了84例中风。在多变量Cox比例风险回归分析中，除了已确定的风险因素外，CAC（每ln（CAC + 1）标准差增加，风险比为1.45 [95%置信区间，1.11 - 1.88]；标准差为2.40）、CIMT（每标准差增加，风险比为1.34 [1.08 - 1.66]；标准差为0.127mm）和ABI（每标准差降低，风险比为1.55 [1.32 - 1.82]；标准差为0.148）均与中风相关。当它们相互组合时，将CIMT（1.41 [1.09 - 1.83]）纳入多变量模型时，ln（CAC + 1）的风险比保持相似，但纳入ABI（1.31 [1.01 - 1.72]）或CIMT与ABI（1.29 [0.99 - 1.68]）时，ln（CAC + 1）的风险比略有下降。尽管仅CAC在已确定的风险因素基础上，在Harrell c统计量中未显著提高曲线下面积（增加0.009；P = 0.379），但CAC与ABI的组合增加了曲线下面积（增加0.029；P = 0.047），ABI单独也增加了曲线下面积（增加0.025；P = 0.038），而CIMT单独增加曲线下面积不显著（增加0.002；P = 0.795）。CAC与ABI的组合还导致了显著的无类别净重新分类和综合鉴别改善。
结论
CAC、CIMT和ABI提供了关于中风风险的互补信息。ABI在一小部分亚人群中具有独特性，预测价值最高，而CIMT分布范围更广，预测价值最低。
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