Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Vascular Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
J Am Coll Cardiol. 2015 Mar 24;65(11):1065-74. doi: 10.1016/j.jacc.2015.01.017.
Although recent studies suggest that measuring coronary artery calcification (CAC) may be superior to indirect atherosclerotic markers in predicting cardiac risk, there are limited data evaluating imaging-based biomarkers that directly quantify atherosclerosis in different vascular beds performed in a single cohort.
The BioImage Study (A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population) sought to identify imaging biomarkers that predict near-term (3-year) atherothrombotic events.
The BioImage Study enrolled 5,808 asymptomatic U.S. adults (mean age: 69 years, 56.5% female) in a prospective cohort evaluating the role of vascular imaging on cardiovascular risk prediction. All patients were evaluated by CAC and novel 3-dimensional carotid ultrasound. Plaque areas from both carotid arteries were summed as the carotid plaque burden (cPB). The primary endpoint was the composite of major adverse cardiac events (MACE) (cardiovascular death, myocardial infarction, and ischemic stroke). A broader secondary MACE endpoint also included all-cause death, unstable angina, and coronary revascularization.
Over a median follow-up of 2.7 years, MACE occurred in 216 patients (4.2%), of which 82 (1.5%) were primary events. After adjustment for risk factors, and compared with individuals without any cPB, hazard ratios for MACE were 0.78 (95% confidence interval [CI]: 0.31 to 1.91), 1.45 (95% CI: 0.67 to 3.14), and 2.36 (95% CI: 1.13 to 4.92) with increasing cPB tertile, with similar results for CAC. Net reclassification significantly improved with either cPB (0.23) or CAC (0.25). MACE rates increased simultaneously with higher levels of both cPB and CAC.
Detection of subclinical carotid or coronary atherosclerosis improves risk predictions and reclassification compared with conventional risk factors, with comparable results for either modality. Cost-effective analyses are warranted to define the optimal roles of these complementary techniques. (BioImage Study: A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population; NCT00738725).
尽管最近的研究表明，测量冠状动脉钙化（CAC）可能比间接的动脉粥样硬化标志物更能预测心脏风险，但在单一队列中评估直接量化不同血管床动脉粥样硬化的基于影像学的生物标志物的数据有限。
BioImage 研究（高危人群动脉粥样硬化疾病负担的临床研究）旨在确定可预测近期（3 年）动脉血栓事件的影像学生物标志物。
BioImage 研究纳入了 5808 名无症状的美国成年人（平均年龄：69 岁，56.5%为女性），这是一项前瞻性队列研究，评估了血管影像学在心血管风险预测中的作用。所有患者均接受 CAC 和新型 3 维颈动脉超声检查。将双侧颈动脉斑块面积相加作为颈动脉斑块负担（cPB）。主要终点是主要不良心脏事件（MACE）的复合终点（心血管死亡、心肌梗死和缺血性卒中）。更广泛的次要 MACE 终点也包括全因死亡、不稳定型心绞痛和冠状动脉血运重建。
中位随访 2.7 年后，216 名患者（4.2%）发生 MACE，其中 82 名（1.5%）为首发事件。在校正危险因素后，与无任何 cPB 的个体相比，MACE 的危险比分别为 0.78（95%可信区间：0.31 至 1.91）、1.45（95%可信区间：0.67 至 3.14）和 2.36（95%可信区间：1.13 至 4.92），cPB 三分位数越高，结果越差，CAC 也有类似结果。无论是 cPB（0.23）还是 CAC（0.25），净重新分类均显著改善。随着 cPB 和 CAC 水平的升高，MACE 发生率也随之升高。
与传统危险因素相比，检测亚临床颈动脉或冠状动脉粥样硬化可改善风险预测和重新分类，两种方法的结果相似。需要进行成本效益分析以确定这些互补技术的最佳作用。（BioImage 研究：高危人群动脉粥样硬化疾病负担的临床研究；NCT00738725）。
