Kim Gee-Hee, Youn Ho-Joong, Choi Yun-Seok, Jung Hae-Ok, Chung Wook-Sung, Kim Chul-Min
Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea Seoul, Republic of Korea.
Department of Internal Medicine, Division of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea Seoul, Republic of Korea.
Int J Clin Exp Med. 2015 Oct 15;8(10):18591-600. eCollection 2015.
In recent clinical practice guidelines for risk assessment for a first atherosclerotic cardiovascular disease (ASCVD) event, it is not routinely recommended to measure carotid intima-media thickness (CIMT) or the coronary calcium score (CACS). The aim of this study was to elucidate the effect of combining carotid artery evaluation and CACS as surrogate markers or predictive values. A total of 938 patients (562 male (59.9%), mean age 61.5±11.6 years) with ASCVD (n=690) or without (n=248) were enrolled in this study. The diagnosis of ASCVD was established with CT angiography. These patients had undergone carotid scanning (HP Sonos-5500; Philips, Bothell, WA, USA) at St. Mary's Hospital between September 2003 and March 2009. ASCVD outcomes were evaluated with a median follow-up of 1451 days. Thirty participants experienced initial ASCVD events during this study. Another 118 patients suffered secondary ASCVD events. After propensity score matching, multivariate analysis revealed that CACS was associated with ASCVD [Odds ratio 1.002, 95% confidence interval (CI) 1.002-1.003, P<0.001]. For primary prevention in patients without ASCVD, we found that carotid plaques [Hazard ratio (HR) 2.409, 95% CI 1.093-5.309, P=0.029] are also associated with ASCVD events. Carotid plaques are also associated with ASCVD events with regard to secondary prevention [HR 1.723, 95% CI 1.188-2.499, P=0.004] in patients with ASCVD. We propose that CACS assessment is useful in the diagnosis of, and as a surrogate marker of ASCVD in patients with risk factors. Our results also suggest that carotid artery evaluation may have a valuable predictive method in primary and secondary ASCVD prevention and risk assessment. Therefore, although there are no synergic effects of combining carotid artery evaluation and CACS, carotid ultrasound seems to be a better predictive method for assessing ASCVD events than CACS.
在近期关于首次动脉粥样硬化性心血管疾病（ASCVD）事件风险评估的临床实践指南中，未常规推荐测量颈动脉内膜中层厚度（CIMT）或冠状动脉钙化积分（CACS）。本研究的目的是阐明将颈动脉评估与CACS相结合作为替代标志物或预测值的效果。本研究共纳入938例患者（562例男性（59.9%），平均年龄61.5±11.6岁），其中患有ASCVD的患者690例，未患ASCVD的患者248例。ASCVD的诊断通过CT血管造影确定。这些患者于2003年9月至2009年3月期间在圣玛丽医院接受了颈动脉扫描（HP Sonos - 5500；飞利浦，美国华盛顿州博塞尔）。对ASCVD结局进行了评估，中位随访时间为1451天。在本研究期间，30名参与者发生了首次ASCVD事件。另外有118例患者发生了继发性ASCVD事件。经过倾向评分匹配后，多因素分析显示CACS与ASCVD相关[比值比1.002，95%置信区间（CI）1.002 - 1.003，P<0.001]。对于无ASCVD的患者进行一级预防时，我们发现颈动脉斑块[风险比（HR）2.409，95%CI 1.093 - 5.309，P = 0.029]也与ASCVD事件相关。对于患有ASCVD的患者进行二级预防时，颈动脉斑块同样与ASCVD事件相关[HR 1.723，95%CI 1.188 - 2.499，P = 0.004]。我们提出，CACS评估对于有危险因素的患者诊断ASCVD以及作为ASCVD的替代标志物是有用的。我们的结果还表明，颈动脉评估在ASCVD一级和二级预防及风险评估中可能是一种有价值的预测方法。因此，虽然将颈动脉评估与CACS联合使用没有协同效应，但颈动脉超声似乎是比CACS更好的评估ASCVD事件的预测方法。
