Clinical cardiology 2018 03 31() doi 10.1002/clc.22952
The aim of the study was to evaluate the incremental prognostic benefit of carotid artery disease and subclinical coronary artery disease (CAD) features in addition to clinical evaluation in a asymptomatic population.
Over a six-year period, 10-year-FRS together with carotid ultrasound (CUS) and coronary computed tomography angiography (CCTA) were evaluated for the prediction of major adverse cardiac events (MACE).
We enrolled 517 consecutive asymptomatic patients (63% male, 64±10 years of age, 17.6% diabetics). Median CACS was 34[0-100]. Over a median follow-up of 4.4[3.4-5.1] years there were a total of 53 MACE (10%). Patients experiencing MACE had higher CACS, higher incidence of carotid disease, presence of CAD≥50%, and remodeled plaque as compared to patients without MACE. At multivariable analyses, presence of CAD≥50% (HR=5.14, 95% CI:2.1-12.4) and percentage of segments with remodeled plaque (HR=1.04, 95% CI:1.03-1.06) independently predict MACE (P<0.001). The models adding CAD≥50% or percentage of segments with remodeled plaque resulted in higher discrimination and reclassification ability compared to a model based on 10-year-FRS, carotid disease and CACS. Specifically, the C-statistic improved up to 0.75 with the addition of CAD and 0.84 when adding percentage of segments with remodeled plaque, while net reclassification improvement index were 0.86 and 0.92 respectively. CONCLUSIONS
In an asymptomatic population, CAD and plaque positive remodeling increase the MACE prediction as compared to a model based on 10-year-FRS, carotid disease, and CACS estimation. In the subgroup of diabetic subjects, the percentage of segments with remodeled plaque is the only predictor of MACE.