Angiology, University Hospital CHUV, Lausanne, Switzerland.
Lipid and Cardiovascular Prevention Unit, University Hospital CHUV, Lausanne, Switzerland.
Vasa. 2021 Jul;50(4):280-285. doi: 10.1024/0301-1526/a000949. Epub 2021 Apr 1.
We carried out this study to evaluate the predictive value of atherosclerosis burden score (ABS) to predict coronary artery disease (CAD) among asymptomatic patients without known cardiovascular disease (CVD), as compared to other imaging or functional techniques, namely coronary artery calcium (CAC) score, carotid intima-media thickness (C-IMT), and ankle brachial index (ABI). This prospective study included 198 asymptomatic consecutive patients referred for evaluation of their cardiovascular (CV) risk and for therapeutic advice. Traditional CV risk factors, ABS, CAC score, C-IMT, ABI and an ECG-synchronized coronary CT-angiography (CCTA) were performed for each patient. We compared the predictive values of these atherosclerosis markers to detect CAD defined as coronary stenosis ≥30% objectivated by CCTA. Among the whole sample, the area under the receiver-operating characteristic curve (ROC-AUC) was significantly higher for CAC score (0.81, p=0.015) than for ABS, the reference (0.70) but these values were lower for C-IMT (0.60, p=0.16) and particularly for ABI (0.56, p=0.0015). However, among patients at intermediate risk of coronary heart disease (CHD), according to Framingham risk score (FRS), the differences between the ROC-AUC values for ABS (0.70) and CAC score (0.76, p=0.36) were less pronounced. Again, as compared to ABS, the ROC-AUC values were lower for C-IMT (0.60, p=0.21) and ABI (0.57, p=0.06). ABS, an ultrasonographic score based on the assessment of carotid and femoral plaque burden, predicts more accurately CAD than other non-radiation tools analyzed here, and has a similar performance to CAC in patients at intermediate CHD risk. Thus, ABS could be an appropriate non-invasive and safe method to improve the detection of high-risk patients who will benefit from a more intensive therapy for the primary prevention of CVD.
我们进行了这项研究，以评估动脉粥样硬化负担评分（ABS）在预测无症状且无已知心血管疾病（CVD）的患者中的冠状动脉疾病（CAD）方面的预测价值，与其他成像或功能技术相比，即冠状动脉钙（CAC）评分、颈动脉内膜中层厚度（C-IMT）和踝臂指数（ABI）。这项前瞻性研究纳入了 198 例连续无症状患者，这些患者被转诊以评估其心血管（CV）风险并获得治疗建议。对每位患者进行了传统的 CV 危险因素、ABS、CAC 评分、C-IMT、ABI 和心电图同步冠状动脉 CT 血管造影（CCTA）。我们比较了这些动脉粥样硬化标志物的预测值，以检测 CCTA 客观确定的≥30%的冠状动脉狭窄定义的 CAD。在整个样本中，CAC 评分的受试者工作特征曲线下面积（ROC-AUC）（0.81，p=0.015）显著高于 ABS（0.70），但低于 C-IMT（0.60，p=0.16），特别是 ABI（0.56，p=0.0015）。然而，在根据弗雷明汉风险评分（FRS）处于中等冠心病（CHD）风险的患者中，ABS（0.70）和 CAC 评分（0.76，p=0.36）的 ROC-AUC 值之间的差异较小。同样，与 ABS 相比，C-IMT（0.60，p=0.21）和 ABI（0.57，p=0.06）的 ROC-AUC 值较低。基于颈动脉和股动脉斑块负担评估的超声评分 ABS 比这里分析的其他非放射性工具更准确地预测 CAD，并且在中等 CHD 风险患者中与 CAC 具有相似的性能。因此，ABS 可能是一种合适的非侵入性和安全方法，可提高高危患者的检出率，这些患者将受益于更强化的 CVD 一级预防治疗。
