Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine.
Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University.
J Atheroscler Thromb. 2018 Aug 1;25(8):709-719. doi: 10.5551/jat.42317. Epub 2018 Jan 26.
To assess whether combining measurements obtained from carotid ultrasonography in addition to the age, creatinine, and ejection fraction (ACEF) score would improve the predictive ability of outcome in patients with acute coronary syndrome (ACS).
We examined 264 patients with ACS (194 men; mean age: 68±11 years) who underwent percutaneous coronary intervention. The carotid plaque score (cPS) and intima-media thickness (cIMT) were determined by carotid ultrasonography. The modified ACEF score was calculated using the following formula: (age/left ventricular ejection fraction) ＋1 point for every 10 mL/min reduction in creatinine clearance below 60 mL/min per 1.73 m. The endpoint of this study was major adverse cardiovascular and cerebrovascular events (MACEs), defined as all-cause death, myocardial infarction, stoke, and target vessel revascularization.
During the median 4-year follow-up, there were 121 incidents of MACEs. Multivariate Cox proportional hazard regression analysis revealed that cPS ≥9.8 (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.01-2.31) and ACEF score ≥1.20 (HR, 1.62; 95% CI, 1.11-2.39) were significantly associated with MACEs, whereas cIMT was not. When the new combined risk score was calculated by multiplying the cPS by the modified ACEF score, the freedom from MACEs at 5 years was 71% and 31% for the lower and higher scores, respectively (p＜0.001). The area under the receiver-operating characteristic curve for MACEs for the ACEF score, cPS, and combined risk score were 0.65, 0.66, and 0.71, respectively (p＜0.05).
The cPS offers an incremental predictive value when combined to the simple ACEF score in ACS.
评估在年龄、肌酐和射血分数（ACEF）评分之外，结合颈动脉超声检查结果，是否能提高急性冠状动脉综合征（ACS）患者预后的预测能力。
我们检查了 264 例接受经皮冠状动脉介入治疗的 ACS 患者（男性 194 例；平均年龄：68±11 岁）。通过颈动脉超声检查确定颈动脉斑块评分（cPS）和内-中膜厚度（cIMT）。改良的 ACEF 评分通过以下公式计算：（年龄/左心室射血分数）+每 10 mL/min 的肌酐清除率降低 60 mL/min/1.73 m 以下，每 10 mL/min 加 1 分。本研究的终点是主要不良心血管和脑血管事件（MACEs），定义为全因死亡、心肌梗死、卒中和靶血管血运重建。
在中位 4 年的随访期间，有 121 例发生 MACEs。多变量 Cox 比例风险回归分析显示，cPS≥9.8（危险比[HR]，1.52；95%置信区间[CI]，1.01-2.31）和 ACEF 评分≥1.20（HR，1.62；95% CI，1.11-2.39）与 MACEs 显著相关，而 cIMT 则不然。当通过将 cPS 乘以改良 ACEF 评分来计算新的联合风险评分时，低评分和高评分组的 5 年无 MACE 率分别为 71%和 31%（p＜0.001）。ACEF 评分、cPS 和联合风险评分对 MACE 的受试者工作特征曲线下面积分别为 0.65、0.66 和 0.71（p＜0.05）。
在 ACS 中，cPS 与简单的 ACEF 评分结合使用可提供额外的预测价值。
