The independent and incremental value of ultrasound carotid plaque length to predict the presence and severity of coronary artery disease: analysis from the carotid plaque length prospective registry
The independent and incremental value of ultrasound carotid plaque length to predict the presence and severity of coronary artery disease: analysis from the carotid plaque length prospective registry
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超声颈动脉斑块长度预测冠状动脉疾病的存在和严重程度的独立和增量价值：颈动脉斑块长度前瞻性登记的分析
DOI：
10.1093/ehjci/jez304
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发表时间：
2020-04-01
影响因子：
6.2
通讯作者：
Zhao, Xianxian
中科院分区：
文献类型：
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作者：
Tang, Wendong;Shen, Xiaxian;Zhao, Xianxian
目的关于颈动脉斑块长度（CPL）与冠状动脉疾病（CAD）之间关系的资料尚缺乏。本研究旨在评估CPL对CAD严重程度的预测价值。方法和结果我们前瞻性地招募了2149例连续患者，这些患者接受了首次冠状动脉造影和颈动脉超声检查，测量了内膜-中膜厚度（IMT）、斑块评分（PS）和cpld。总共有1408例（65.5%）患者患有CAD（定义为狭窄bb0 = 50%）， 741例（34.5%）患者没有CAD。冠心病患者的最大CPL比非冠心病患者长（P < 0.001）。以Gensini评分（GS）衡量的CAD严重程度与max-CPL密切相关（r(s) = 0.560），其次是PS （r(s) = 0.486）和mean-IMT （r(s) = 0.292）。多因素分析显示，在调整传统危险因素（TRF）后，max-CPL与CAD和高gs仍然独立相关。Max-CPL预测高gs值的判别值显著高于PS和mean-IMT[曲线下面积（AUC） 0.819比0.769比0.634,P < 0.001]。在最大cpl为6.3 mm的临界值下，高gs的敏感性和阴性预测值分别为84.6%和89.1%。此外，与TRF相比，max-CPL的添加显著提高了高gs的识别（AUC 0.832 vs. 0.720, P < 0.001）和重分类（净重分类改善= 0.431,P < 0.001）。结论超声max-CPL对冠心病临床严重程度优于TRF有独立的、递增的预测价值，是一种简单实用的冠心病危险分层指标。
Aims Data regarding the relationship between carotid plaque length (CPL) and coronary artery disease (CAD) are lacking. This study aimed to assess the predictive value of CPL for the severity of CAD.Methods and results We prospectively enrolled 2149 consecutive patients who underwent both first coronary angiography and carotid ultrasonography with measurements of intima-media thickness (IMT), plaque score (PS), and CPL. In total, 1408 (65.5%) patients had CAD (defined as stenosis >= 50%), and 741 (34.5%) patients had no CAD. Patients with CAD had longer maximal CPL than those without CAD (P < 0.001). The severity of CAD, measured by the Gensini score (GS), was closely correlated with max-CPL (r(s) = 0.560), followed by PS (r(s) = 0.486) and mean-IMT (r(s) = 0.292). Multivariate analysis revealed that max-CPL remained independently associated with CAD and high-GS after adjustment for traditional risk factors (TRF). Max-CPL, compared with PS or mean-IMT, had significantly higher discrimination value for predicting high-GS [area under the curve (AUC) 0.819 vs. 0.769 vs. 0.634, P < 0.001]. At a cut-off value for the max-CPL of 6.3 mm, the sensitivity and negative predictive value for high-GS were 84.6% and 89.1%, respectively. Furthermore, the addition of max-CPL significantly improved the discrimination (AUC 0.832 vs. 0.720, P < 0.001) and reclassification (net reclassification improvement = 0.431, P < 0.001) over TRF for high-GS.Conclusion Ultrasound max-CPL provides independent and incremental predictive value for the clinical severity of CAD over TRF and seems a simple useful marker in CAD risk stratification.