应用颈动脉斑块总面积增加 SCORE2 对中年人群进行斑块成像的预后影响：ARteris 心血管结局（ARCO）队列研究。
Prognostic impact of carotid plaque imaging using total plaque area added to SCORE2 in middle-aged subjects: the ARteris Cardiovascular Outcome (ARCO) cohort study.
机构信息
Vascular Risk Foundation (Varifo), Olten, Switzerland.
BAD Gesundheitsvorsorge und Sicherheitstechnik GmbH, Bonn, Germany.
出版信息
Swiss Med Wkly. 2024 Jan 25;154:3735. doi: 10.57187/s.3735.
AIMS
Many cardiovascular events occur in seemingly healthy individuals.We set out to assess the predictive value of atherosclerosis imaging in combination with cardiovascular risk calculators in subjects aged 40-65 years.
METHODS
We compared PROCAM (PROspective CArdiovascular Münster study), SCORE (Systematic COronary Risk Evaluation) and SCORE2 with carotid ultrasound (total plaque area, TPA) in subjects without cardiovascular disease. In this prospective cohort study, follow-up was obtained by phone or mail from patients; or from clinical records, if needed.
RESULTS
In 2842 subjects (mean age 50±8 years; 38% women), cardiovascular events occurred in 154 (5.4%) of them over an mean follow-up period of 5.9 (range 1-12) years, specifically: 41 cases of AMI (myocardial infarction), 16 strokes, 21 CABG (coronary artery bypass grafting), 41 PTCA (percutaneous transluminal coronary angioplasty) and 35 CAD (coronary artery disease). Mean PROCAM risk was 5±6%, mean SCORE risk was 1.3±1.6% and mean SCORE2 risk was 5±3%. Both for the primary outcome (major adverse cardiovascular events, MACEs, i.e. AMI + strokes) and the secondary outcome (atherosclerotic cardiovascular disease, ASCVD, i.e. MACEs + CABG + CAD + PTCA), hazards increased significantly for TPA tertiles and SCORE2 post-test risk between 6.7 to 12.8 after adjustment for risk factors (age, smoke, sex, systolic blood pressure, lipids, medication) and after adjustment for results from PROCAM, SCORE and SCORE2. Model performance was statistically improved regarding model fit in all models using TPA. Net reclassification improvement for SCORE2 with TPA post-test risk increased significantly by 24% for MACEs (p = 0.01) and 39% for ASCVD (p <0.0001).
CONCLUSIONS
Integration of TPA post-test risk into SCORE2 adds prognostic information, supporting the use of carotid ultrasound when assessing ASCVD risk in subjects aged 40-65 years.
目的
许多心血管事件发生在看似健康的个体中。我们旨在评估动脉粥样硬化成像与心血管风险计算器相结合在 40-65 岁人群中的预测价值。
方法
我们比较了 PROCAM（前瞻性心血管明斯特研究）、SCORE（系统性冠状动脉风险评估）和 SCORE2 与颈动脉超声（总斑块面积，TPA）在无心血管疾病的患者中的应用。在这项前瞻性队列研究中，通过电话或邮件从患者处获得随访；或者，如果需要，从临床记录中获得。
结果
在 2842 名受试者（平均年龄 50±8 岁；38%为女性）中，154 名（5.4%）在平均 5.9（范围 1-12）年的随访期间发生了心血管事件，具体为：41 例 AMI（心肌梗死），16 例中风，21 例 CABG（冠状动脉旁路移植术），41 例 PTCA（经皮腔内冠状动脉血管成形术）和 35 例 CAD（冠状动脉疾病）。PROCAM 风险平均为 5±6%，SCORE 风险平均为 1.3±1.6%，SCORE2 风险平均为 5±3%。对于主要终点（主要不良心血管事件，MACE，即 AMI+中风）和次要终点（动脉粥样硬化性心血管疾病，ASCVD，即 MACE+CABG+CAD+PTCA），TPA 三分位和 SCORE2 后验风险均显著增加风险因素（年龄、吸烟、性别、收缩压、血脂、药物）调整后为 6.7 至 12.8，PROCAM、SCORE 和 SCORE2 结果调整后。在所有模型中，使用 TPA 后，模型拟合的统计学均有所改善。对于 MACEs，SCORE2 与 TPA 后验风险的净重新分类改善显著增加了 24%（p=0.01），对于 ASCVD，增加了 39%（p<0.0001）。
结论
将 TPA 后验风险纳入 SCORE2 增加了预后信息，支持在评估 40-65 岁人群的 ASCVD 风险时使用颈动脉超声。
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