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Carotid ultrasonography improves residual risk stratification in guidelines-defined high cardiovascular risk patients: risk prediction/assessment and stratification

The clinical value of carotid atherosclerosis markers for residual risk stratification in high atherosclerotic cardiovascular disease (ASCVD) risk patients is not established. We aimed to derive and validate optimal values of markers of carotid subclinical atherosclerosis improving risk stratificati...

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Main Authors: Georgiopoulos, Georgios (Author) , Mavraganis, Georgios (Author) , Delialis, Dimitrios (Author) , Georgiou, Stelios (Author) , Aivalioti, Evmorfia (Author) , Patras, Raphael (Author) , Petropoulos, Ioannis (Author) , Dimopoulou, Maria-Angeliki (Author) , Angelidakis, Lasthenis (Author) , Sianis, Alexandros (Author) , Bampatsias, Dimitrios (Author) , Dimoula, Anna (Author) , Maneta, Eleni (Author) , Kosmopoulos, Marinos (Author) , Vardavas, Constantine (Author) , Stellos, Konstantinos (Author) , Stamatelopoulos, Kimon (Author)
Format: Article (Journal)
Language:English
Published: 17 May 2022
In: European journal of preventive cardiology
Year: 2022, Volume: 29, Issue: 13, Pages: 1773-1784
ISSN:2047-4881
DOI:10.1093/eurjpc/zwac095
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1093/eurjpc/zwac095
Verlag, lizenzpflichtig, Volltext: https://academic.oup.com/eurjpc/article/29/13/1773/6587042?login=true
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Author Notes:Georgios Georgiopoulos, Georgios Mavraganis, Dimitrios Delialis, Stelios Georgiou, Evmorfia Aivalioti, Raphael Patras, Ioannis Petropoulos, Maria-Angeliki Dimopoulou, Lasthenis Angelidakis, Alexandros Sianis, Dimitrios Bampatsias, Anna Dimoula, Eleni Maneta, Marinos Kosmopoulos, Constantine Vardavas, Konstantinos Stellos, Kimon Stamatelopoulos
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Summary:The clinical value of carotid atherosclerosis markers for residual risk stratification in high atherosclerotic cardiovascular disease (ASCVD) risk patients is not established. We aimed to derive and validate optimal values of markers of carotid subclinical atherosclerosis improving risk stratification in guidelines-defined high ASCVD risk patients.We consecutively analysed high or very high ASCVD risk patients from a cardiovascular (CV) prevention registry (n = 751, derivation cohort) and from the Atherosclerosis Risk in Communities (ARIC) study (n = 2,897, validation cohort). Baseline ASCVD risk was defined using the 2021 European Society of Cardiology guidelines (clinical ESCrisk). Intima-media thickness excluding plaque, average maximal (avg.maxWT), maximal wall thickness (maxWT) and number of sites with carotid plaque were assessed. As primary endpoint of the study was defined the composite of cardiac death, acute myocardial infarction and revascularization after a median of 3.4 years in both cohorts and additionally for 16.7 years in the ARIC cohort.MaxWT > 2.00 mm and avg.maxWT > 1.39 mm provided incremental prognostic value, improved discrimination and correctly reclassified risk over the clinical ESCrisk both in the derivation and the validation cohort (P < 0.05 for net reclassification index, integrated discrimination index and Delta Harrell’s C index). MaxWT < 0.9 mm predicted very low probability of CV events (negative predictive value = 97% and 92% in the derivation and validation cohort, respectively). These findings were additionally confirmed for very long-term events in the validation cohort.Integration of carotid ultrasonography in guidelines-defined risk stratification may identify patients at very high-risk in need for further residual risk reduction or at very low probability for events.
Item Description:Gesehen am 07.08.2023
Physical Description:Online Resource
ISSN:2047-4881
DOI:10.1093/eurjpc/zwac095

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