The role of carotid arterial intima-media thickness in predicting clinical coronary events
The role of carotid arterial intima-media thickness in predicting clinical coronary events
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DOI：
10.7326/0003-4819-128-4-199802150-00002
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发表时间：
1998-02-15
影响因子：
39.2
通讯作者：
Azen, SP
中科院分区：
文献类型：
--
作者：
Hodis, HN;Mack, WJ;Azen, SP
背景：颈动脉内膜中层厚度被用作衡量动脉粥样硬化进展的无创替代终点，但其与冠状动脉事件的关系尚未得到充分探讨。目的：确定颈动脉内膜中层厚度是否可以预测冠状动脉事件。设计：对完成 2 年降低胆固醇动脉粥样硬化研究的先前组装队列进行长期随访（平均 8.8 年），一项随机动脉成像试验，旨在研究降脂对动脉粥样硬化进展的影响。地点：大学超声检查实验室。患者：146 名 40 至 59 岁的男性，曾接受过冠状动脉搭桥手术。测量方法：每 6 个月用 B 型超声检查评估颈总动脉侵入前动脉粥样硬化，并评估冠状动脉侵入性动脉粥样硬化在基线和 2 年时进行定量冠状动脉造影。试验结束后，记录冠状动脉事件（非致命性急性心肌梗死、冠状动脉死亡和冠状动脉血运重建）的发生率。结果：颈动脉内膜中层厚度每年每增加 0.03 毫米，非致命性心肌梗死或冠状动脉死亡的相对风险为 2.2（95% Cl，1.4 至 3.6），任何冠状动脉事件的相对风险为 3.1（Cl， 2.1 至 4.5）（P < 0.001）。绝对内膜中层厚度也与临床冠状动脉事件的风险相关（P < 0.02）。绝对厚度和厚度进展预测冠状动脉事件的风险超出了冠状动脉动脉粥样硬化测量和血脂测量所预测的风险（P < 0.001）。 结论：无创 B 型超声测量远端颈总动脉内膜中层厚度进展是临床冠状动脉事件的有用替代终点。
Background: Carotid arterial intima-media thickness is used as a noninvasive surrogate end point to measure progression of atherosclerosis, but its relation to coronary events has not been fully explored.Objective: To determine whether carotid arterial intimamedia thickness predicts coronary events.Design: Long-term follow-up (average, 8.8 years) of a previously assembled cohort of persons who completed the 2-year Cholesterol Lowering Atherosclerosis Study, a randomized arterial imaging trial designed to study the effects of lipid lowering on progression of atherosclerosis.Setting: University-based ultrasonography laboratory.Patients: 146 men 40 to 59 years of age who had previously had coronary artery bypass graft surgery.Measurements: Preintrusive atherosclerosis in the common carotid artery was evaluated every 6 months with B-mode ultrasonography, and intrusive atherosclerosis in the coronary arteries was evaluated at baseline and at 2 years with quantitative coronary angiography. After the trial, the incidences of coronary events (nonfatal acute myocardial infarction, coronary death, and coronary artery revascularization) were documented.Results: For each 0.03-mm increase per year in carotid arterial intima-media thickness, the relative risk for non-fatal myocardial infarction or coronary death was 2.2 (95 % Cl, 1.4 to 3.6) and the relative risk for any coronary event was 3.1 (Cl, 2.1 to 4.5) (P < 0.001). Absolute intima-media thickness was also related to risk for clinical coronary events (P < 0.02). Absolute thickness and progression in thickness predicted risk for coronary events beyond that predicted by coronary arterial measures of atherosclerosis and lipid measurements (P < 0.001).Conclusion: Noninvasive B-mode ultrasonographic measurement of progression of intima-media thickness in the distal common carotid artery is a useful surrogate end point for clinical coronary events.