Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and nondiabetic asymptomatic population

A.I. Guaricci, V. Lorenzoni, M. Guglielmo, S. Mushtaq, G. Muscogiuri, F. Cademartiri, M. Rabbat, D. Andreini, G. Serviddio, N. Gaibazzi, M. Pepi, G. Pontone

Research output: Contribution to journalArticle

Abstract

Background: We sought to evaluate the incremental prognostic benefit of carotid artery disease and subclinical coronary artery disease (CAD) features in addition to clinical evaluation in an asymptomatic population. Methods: Over a 6-year period, 10-year Framingham risk score together with carotid ultrasound and coronary computed tomography angiography were evaluated for prediction of major adverse cardiac events (MACE). Results: We enrolled 517 consecutive asymptomatic patients (63% male, mean age 64 ±10 years; 17.6% with diabetes). Median (interquartile range) coronary artery calcium score (CACS) was 34 (0–100). Over a median follow-up of 4.4 (3.4–5.1) years, there were 53 MACE (10%). Patients experiencing MACE had higher CACS, incidence of carotid disease, presence of CAD ≥50%, and remodeled plaque as compared with 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 predicted MACE (P <0.001). Models adding CAD ≥50% or percentage of segments with remodeled plaque resulted in higher discrimination and reclassification ability compared with a model based on 10-year FRS, carotid disease, and CACS. Specifically, the C-statistic improved to 0.75 with addition of CAD and 0.84 when adding percentage of segments with remodeled plaque, whereas net reclassification improvement indices were 0.86 and 0.92, respectively. Conclusions: In an asymptomatic population, CAD and plaque positive remodeling increase MACE prediction compared with a model based on 10-year FRS, carotid disease, and CACS estimation. In the diabetes subgroup, percentage of segments with remodeled plaque was the only predictor of MACE. © 2018 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)769-777
Number of pages9
JournalClinical Cardiology
Volume41
Issue number6
DOIs
Publication statusPublished - 2018

Fingerprint

Carotid Artery Diseases
Coronary Artery Disease
Population
Calcium
Coronary Vessels
Incidence

Keywords

  • Calcium Scoring
  • Cardiovascular Prevention
  • Carotid Disease
  • Computed Tomography
  • Coronary Artery Disease
  • Diabetes Mellitus
  • Subclinical Atherosclerosis
  • adult
  • Article
  • carotid atherosclerosis
  • clinical evaluation
  • computed tomographic angiography
  • controlled study
  • coronary artery atherosclerosis
  • coronary artery calcium score
  • diabetes mellitus
  • female
  • follow up
  • Framingham risk score
  • human
  • incidence
  • intravascular ultrasound
  • major adverse cardiac event
  • major clinical study
  • male
  • prognostic assessment
  • retrospective study
  • vascular remodeling
  • aged
  • arterial wall thickness
  • asymptomatic disease
  • atherosclerotic plaque
  • blood vessel calcification
  • carotid artery disease
  • chi square distribution
  • coronary angiography
  • coronary artery disease
  • diagnostic imaging
  • Italy
  • middle aged
  • multidetector computed tomography
  • multivariate analysis
  • procedures
  • prognosis
  • proportional hazards model
  • risk factor
  • time factor
  • Aged
  • Asymptomatic Diseases
  • Carotid Artery Diseases
  • Carotid Intima-Media Thickness
  • Chi-Square Distribution
  • Computed Tomography Angiography
  • Coronary Angiography
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Multivariate Analysis
  • Plaque, Atherosclerotic
  • Prognosis
  • Proportional Hazards Models
  • Risk Factors
  • Time Factors
  • Vascular Calcification

Cite this

Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and nondiabetic asymptomatic population. / Guaricci, A.I.; Lorenzoni, V.; Guglielmo, M.; Mushtaq, S.; Muscogiuri, G.; Cademartiri, F.; Rabbat, M.; Andreini, D.; Serviddio, G.; Gaibazzi, N.; Pepi, M.; Pontone, G.

In: Clinical Cardiology, Vol. 41, No. 6, 2018, p. 769-777.

Research output: Contribution to journalArticle

Guaricci, AI, Lorenzoni, V, Guglielmo, M, Mushtaq, S, Muscogiuri, G, Cademartiri, F, Rabbat, M, Andreini, D, Serviddio, G, Gaibazzi, N, Pepi, M & Pontone, G 2018, 'Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and nondiabetic asymptomatic population', Clinical Cardiology, vol. 41, no. 6, pp. 769-777. https://doi.org/10.1002/clc.22952
Guaricci, A.I. ; Lorenzoni, V. ; Guglielmo, M. ; Mushtaq, S. ; Muscogiuri, G. ; Cademartiri, F. ; Rabbat, M. ; Andreini, D. ; Serviddio, G. ; Gaibazzi, N. ; Pepi, M. ; Pontone, G. / Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and nondiabetic asymptomatic population. In: Clinical Cardiology. 2018 ; Vol. 41, No. 6. pp. 769-777.
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title = "Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and nondiabetic asymptomatic population",
abstract = "Background: We sought to evaluate the incremental prognostic benefit of carotid artery disease and subclinical coronary artery disease (CAD) features in addition to clinical evaluation in an asymptomatic population. Methods: Over a 6-year period, 10-year Framingham risk score together with carotid ultrasound and coronary computed tomography angiography were evaluated for prediction of major adverse cardiac events (MACE). Results: We enrolled 517 consecutive asymptomatic patients (63{\%} male, mean age 64 ±10 years; 17.6{\%} with diabetes). Median (interquartile range) coronary artery calcium score (CACS) was 34 (0–100). Over a median follow-up of 4.4 (3.4–5.1) years, there were 53 MACE (10{\%}). Patients experiencing MACE had higher CACS, incidence of carotid disease, presence of CAD ≥50{\%}, and remodeled plaque as compared with 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 predicted MACE (P <0.001). Models adding CAD ≥50{\%} or percentage of segments with remodeled plaque resulted in higher discrimination and reclassification ability compared with a model based on 10-year FRS, carotid disease, and CACS. Specifically, the C-statistic improved to 0.75 with addition of CAD and 0.84 when adding percentage of segments with remodeled plaque, whereas net reclassification improvement indices were 0.86 and 0.92, respectively. Conclusions: In an asymptomatic population, CAD and plaque positive remodeling increase MACE prediction compared with a model based on 10-year FRS, carotid disease, and CACS estimation. In the diabetes subgroup, percentage of segments with remodeled plaque was the only predictor of MACE. {\circledC} 2018 Wiley Periodicals, Inc.",
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author = "A.I. Guaricci and V. Lorenzoni and M. Guglielmo and S. Mushtaq and G. Muscogiuri and F. Cademartiri and M. Rabbat and D. Andreini and G. Serviddio and N. Gaibazzi and M. Pepi and G. Pontone",
note = "Cited By :2 Export Date: 1 February 2019 CODEN: CLCAD Correspondence Address: Guaricci, A.I.; Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital PoliclinicoItaly; email: andrea.guaricci@gmail.com Manufacturers: VK Medical, India; GE Healthcare, United States References: Mozaffarian, D., Benjamin, E.J., Go, A.S., Heart Disease and Stroke Statistics—2016 Update: a report from the American Heart Association [published correction appears in Circulation. 2016;133:e599] (2016) Circulation., 133, pp. e38-e360; Barton, P., Andronis, L., Briggs, A., Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: modelling study (2011) BMJ., 343. , d4044; Nambi, V., Chambless, L., Folsom, A.R., Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC (Atherosclerosis Risk In Communities) study (2010) J Am Coll Cardiol., 55, pp. 1600-1607; Baber, U., Mehran, R., Sartori, S., Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study (2015) J Am Coll Cardiol., 65, pp. 1065-1074; Guaricci, A.I., Brunetti, N.D., Di Biase, M., Cardiovascular clinical risk constrains to a powerful primary prevention: carotid atherosclerosis in toto and low dose computed tomography coronary angiography? (2015) Int J Cardiol., 178, pp. 147-148; Maffei, E., Seitun, S., Nieman, K., Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus (2011) Eur Radiol., 21, pp. 944-953; Cho, I., Chang, H.J., Hartaigh, B.O., Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: results from the Coronary CT Angiography Evaluation for Clinical Outcomes International Multicenter (CONFIRM) study [published correction appears in Eur Heart J. 2015;36:3287] (2015) Eur Heart J, 36, pp. 501-508; Maffei, E., Seitun, S., Guaricci, A.I., Chest pain: coronary CT in the ER (2016) Br J Radiol., 89. , 20150954; Min, J.K., Labounty, T.M., Gomez, M.J., Incremental prognostic value of coronary computed tomographic angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals (2014) Atherosclerosis., 232, pp. 298-304; D'Agostino, R.B., Sr., Vasan, R.S., Pencina, M.J., General cardiovascular risk profile for use in primary care: the Framingham Heart Study (2008) Circulation., 117, pp. 743-753; Touboul, P.J., Hennerici, M.G., Meairs, S., Mannheim carotid intima-media thickness and plaque consensus (2004–2006–2011): an update on behalf of the advisory board of the 3rd, 4th and 5th Watching the Risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004; Brussels, Belgium, 2006; and Hamburg, Germany, 2011 (2012) Cerebrovasc Dis., 34, pp. 290-296; Guaricci, A.I., Schuijf, J.D., Cademartiri, F., Incremental value and safety of oral ivabradine for heart rate reduction in computed tomography coronary angiography (2012) Int J Cardiol., 156, pp. 28-33; Guaricci, A.I., Maffei, E., Brunetti, N.D., Heart rate control with oral ivabradine in computed tomography coronary angiography: a randomized comparison of 7.5 mg vs 5 mg regimen (2013) Int J Cardiol., 168, pp. 362-368; Pontone, G., Bertella, E., Mushtaq, S., Coronary artery disease: diagnostic accuracy of CT coronary angiography—a comparison of high and standard spatial resolution scanning (2014) Radiology., 271, pp. 688-694; Geleijns, J., Golding, S., Menzel, H.G., A workshop on quality criteria for computed tomography held in Arhus, Denmark, November 1998 (2000) Eur Radiol., 10, pp. 544-545; Austen, W.G., Edwards, J.E., Frye, R.L., A reporting system for patients evaluated for coronary artery disease: report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, America Heart Association (1975) Circulation., 51 (4), pp. 5-40; Hoffmann, U., Moselewski, F., Nieman, K., Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography (2006) J Am Coll Cardiol., 47, pp. 1655-1662; Thygesen, K., Alpert, J.S., White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction (2007) Circulation., 116, pp. 2634-2653; Anderson, J.L., Adams, C.D., Antman, E.M., American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2013;127:e863–e864] (2013) Circulation., 127, pp. e663-e828; Pencina, M.J., D'Agostino, R.B., Sr., Steyerberg, E.W., Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers (2011) Stat Med., 30, pp. 11-21; Amato, M., Montorsi, P., Ravani, A., Carotid intima-media thickness by B-mode ultrasound as surrogate of coronary atherosclerosis: correlation with quantitative coronary angiography and coronary intravascular ultrasound findings (2007) Eur Heart J., 28, pp. 2094-2101; Gaibazzi, N., Rigo, F., Facchetti, R., Differential incremental value of ultrasound carotid intima-media thickness, carotid plaque, and cardiac calcium to predict angiographic coronary artery disease across Framingham risk score strata in the APRES multicentre study (2015) Eur Heart J Cardiovasc Imaging., 17, pp. 991-1000; Cohen, G.I., Aboufakher, R., Bess, R., Relationship between carotid disease on ultrasound and coronary disease on CT angiography (2013) JACC Cardiovasc Imaging., 6, pp. 1160-1167; Guaricci, A.I., Arcadi, T., Brunetti, N.D., Carotid intima-media thickness and coronary atherosclerosis linkage in symptomatic intermediate-risk patients evaluated by coronary computed tomography angiography (2014) Int J Cardiol., 176, pp. 988-993; Xie, W., Liang, L., Zhao, L., Combination of carotid intima-media thickness and plaque for better predicting risk of ischaemic cardiovascular events in Chinese subjects (2011) Heart., 97, pp. 1326-1331; Rumberger, J.A., Simons, D.B., Fitzpatrick, L.A., Coronary artery calcium area by electron beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study (1995) Circulation., 92, pp. 2157-2162; Arad, Y., Goodman, K.J., Roth, M., Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart study (2005) J Am Coll Cardiol., 46, pp. 158-165; Detrano, R., Guerci, A.D., Carr, J.J., Coronary calcium as a predictor of coronary events in four racial or ethnic groups (2008) N Engl J Med., 358, pp. 1336-1345; Achenbach, S., Goroll, T., Seltmann, M., Detection of coronary artery stenoses by low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography (2011) JACC Cardiovasc Imaging., 4, pp. 328-337; Achenbach, S., Narula, J., Coronary CT angiography: from sensitivity to specificity (2011) JACC Cardiovasc Imaging., 4, pp. 1227-1229; Neglia, D., Rovai, D., Caselli, C., Detection of significant coronary artery disease by noninvasive anatomical and functional imaging (2015) Circ Cardiovasc Imaging, 8. , https://doi.org/10.1161/CIRCIMAGING.114.002179; Maffei, E., Seitun, S., Martini, C., Prognostic value of computed tomography coronary angiography in patients with chest pain of suspected cardiac origin [article in English and Polish] (2011) Radiol Med., 116, pp. 690-705; Shaw, L.J., Hausleiter, J., Achenbach, S., Coronary computed tomographic angiography as a gatekeeper to invasive diagnostic and surgical procedures: results from the multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: an International Multicenter) registry (2012) J Am Coll Cardiol., 60, pp. 2103-2114; Nucifora, G., Schuijf, J.D., van Werkhoven, J.M., Prevalence of coronary artery disease across the Framingham risk categories: coronary artery calcium scoring and MSCT coronary angiography (2009) J Nucl Cardiol., 16, pp. 368-375; Motoyama, S., Kondo, T., Sarai, M., Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes (2007) J Am Coll Cardiol., 50, pp. 319-326; Maurovich-Horvat, P., Hoffmann, U., Vorpahl, M., The napkin-ring sign: CT signature of high-risk coronary plaques? (2010) JACC Cardiovasc Imaging., 3, pp. 440-444; Motoyama, S., Ito, H., Sarai, M., Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up (2015) J Am Coll Cardiol., 66, pp. 337-346; Thomsen, C., Abdulla, J., Characteristics of high-risk coronary plaques identified by computed tomographic angiography and associated prognosis: a systematic review and meta-analysis (2016) Eur Heart J Cardiovasc Imaging., 17, pp. 120-129; Guaricci, A.I., Pontone, G., Fusini, L., Additional value of inflammatory biomarkers and carotid artery disease in prediction of significant coronary artery disease as assessed by coronary computed tomography angiography (2017) Eur Heart J Cardiovasc Imaging., 18, pp. 1049-1056; Haffner, S.M., Lehto, S., R{\"o}nnemaa, T., Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction (1998) N Engl J Med., 339, pp. 229-234; Maffei, E., Seitun, S., Nieman, K., Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus (2011) Eur Radiol., 21, pp. 944-953; Fox, C.S., Golden, S.H., Anderson, C., Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a Scientific Statement from the American Heart Association and the American Diabetes Association (2015) Diabetes Care., 38, pp. 1777-1803; Rana, J.S., Liu, J.Y., Moffet, H.H., Diabetes and prior coronary heart disease are not necessarily risk equivalent for future coronary heart disease events (2016) J Gen Intern Med., 31, pp. 387-393",
year = "2018",
doi = "10.1002/clc.22952",
language = "English",
volume = "41",
pages = "769--777",
journal = "Clinical Cardiology",
issn = "0160-9289",
publisher = "John Wiley and Sons Inc.",
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}

TY - JOUR

T1 - Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and nondiabetic asymptomatic population

AU - Guaricci, A.I.

AU - Lorenzoni, V.

AU - Guglielmo, M.

AU - Mushtaq, S.

AU - Muscogiuri, G.

AU - Cademartiri, F.

AU - Rabbat, M.

AU - Andreini, D.

AU - Serviddio, G.

AU - Gaibazzi, N.

AU - Pepi, M.

AU - Pontone, G.

N1 - Cited By :2 Export Date: 1 February 2019 CODEN: CLCAD Correspondence Address: Guaricci, A.I.; Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital PoliclinicoItaly; email: andrea.guaricci@gmail.com Manufacturers: VK Medical, India; GE Healthcare, United States References: Mozaffarian, D., Benjamin, E.J., Go, A.S., Heart Disease and Stroke Statistics—2016 Update: a report from the American Heart Association [published correction appears in Circulation. 2016;133:e599] (2016) Circulation., 133, pp. e38-e360; Barton, P., Andronis, L., Briggs, A., Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: modelling study (2011) BMJ., 343. , d4044; Nambi, V., Chambless, L., Folsom, A.R., Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC (Atherosclerosis Risk In Communities) study (2010) J Am Coll Cardiol., 55, pp. 1600-1607; Baber, U., Mehran, R., Sartori, S., Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study (2015) J Am Coll Cardiol., 65, pp. 1065-1074; Guaricci, A.I., Brunetti, N.D., Di Biase, M., Cardiovascular clinical risk constrains to a powerful primary prevention: carotid atherosclerosis in toto and low dose computed tomography coronary angiography? (2015) Int J Cardiol., 178, pp. 147-148; Maffei, E., Seitun, S., Nieman, K., Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus (2011) Eur Radiol., 21, pp. 944-953; Cho, I., Chang, H.J., Hartaigh, B.O., Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: results from the Coronary CT Angiography Evaluation for Clinical Outcomes International Multicenter (CONFIRM) study [published correction appears in Eur Heart J. 2015;36:3287] (2015) Eur Heart J, 36, pp. 501-508; Maffei, E., Seitun, S., Guaricci, A.I., Chest pain: coronary CT in the ER (2016) Br J Radiol., 89. , 20150954; Min, J.K., Labounty, T.M., Gomez, M.J., Incremental prognostic value of coronary computed tomographic angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals (2014) Atherosclerosis., 232, pp. 298-304; D'Agostino, R.B., Sr., Vasan, R.S., Pencina, M.J., General cardiovascular risk profile for use in primary care: the Framingham Heart Study (2008) Circulation., 117, pp. 743-753; Touboul, P.J., Hennerici, M.G., Meairs, S., Mannheim carotid intima-media thickness and plaque consensus (2004–2006–2011): an update on behalf of the advisory board of the 3rd, 4th and 5th Watching the Risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004; Brussels, Belgium, 2006; and Hamburg, Germany, 2011 (2012) Cerebrovasc Dis., 34, pp. 290-296; Guaricci, A.I., Schuijf, J.D., Cademartiri, F., Incremental value and safety of oral ivabradine for heart rate reduction in computed tomography coronary angiography (2012) Int J Cardiol., 156, pp. 28-33; Guaricci, A.I., Maffei, E., Brunetti, N.D., Heart rate control with oral ivabradine in computed tomography coronary angiography: a randomized comparison of 7.5 mg vs 5 mg regimen (2013) Int J Cardiol., 168, pp. 362-368; Pontone, G., Bertella, E., Mushtaq, S., Coronary artery disease: diagnostic accuracy of CT coronary angiography—a comparison of high and standard spatial resolution scanning (2014) Radiology., 271, pp. 688-694; Geleijns, J., Golding, S., Menzel, H.G., A workshop on quality criteria for computed tomography held in Arhus, Denmark, November 1998 (2000) Eur Radiol., 10, pp. 544-545; Austen, W.G., Edwards, J.E., Frye, R.L., A reporting system for patients evaluated for coronary artery disease: report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, America Heart Association (1975) Circulation., 51 (4), pp. 5-40; Hoffmann, U., Moselewski, F., Nieman, K., Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography (2006) J Am Coll Cardiol., 47, pp. 1655-1662; Thygesen, K., Alpert, J.S., White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction (2007) Circulation., 116, pp. 2634-2653; Anderson, J.L., Adams, C.D., Antman, E.M., American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2013;127:e863–e864] (2013) Circulation., 127, pp. e663-e828; Pencina, M.J., D'Agostino, R.B., Sr., Steyerberg, E.W., Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers (2011) Stat Med., 30, pp. 11-21; Amato, M., Montorsi, P., Ravani, A., Carotid intima-media thickness by B-mode ultrasound as surrogate of coronary atherosclerosis: correlation with quantitative coronary angiography and coronary intravascular ultrasound findings (2007) Eur Heart J., 28, pp. 2094-2101; Gaibazzi, N., Rigo, F., Facchetti, R., Differential incremental value of ultrasound carotid intima-media thickness, carotid plaque, and cardiac calcium to predict angiographic coronary artery disease across Framingham risk score strata in the APRES multicentre study (2015) Eur Heart J Cardiovasc Imaging., 17, pp. 991-1000; Cohen, G.I., Aboufakher, R., Bess, R., Relationship between carotid disease on ultrasound and coronary disease on CT angiography (2013) JACC Cardiovasc Imaging., 6, pp. 1160-1167; Guaricci, A.I., Arcadi, T., Brunetti, N.D., Carotid intima-media thickness and coronary atherosclerosis linkage in symptomatic intermediate-risk patients evaluated by coronary computed tomography angiography (2014) Int J Cardiol., 176, pp. 988-993; Xie, W., Liang, L., Zhao, L., Combination of carotid intima-media thickness and plaque for better predicting risk of ischaemic cardiovascular events in Chinese subjects (2011) Heart., 97, pp. 1326-1331; Rumberger, J.A., Simons, D.B., Fitzpatrick, L.A., Coronary artery calcium area by electron beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study (1995) Circulation., 92, pp. 2157-2162; Arad, Y., Goodman, K.J., Roth, M., Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart study (2005) J Am Coll Cardiol., 46, pp. 158-165; Detrano, R., Guerci, A.D., Carr, J.J., Coronary calcium as a predictor of coronary events in four racial or ethnic groups (2008) N Engl J Med., 358, pp. 1336-1345; Achenbach, S., Goroll, T., Seltmann, M., Detection of coronary artery stenoses by low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography (2011) JACC Cardiovasc Imaging., 4, pp. 328-337; Achenbach, S., Narula, J., Coronary CT angiography: from sensitivity to specificity (2011) JACC Cardiovasc Imaging., 4, pp. 1227-1229; Neglia, D., Rovai, D., Caselli, C., Detection of significant coronary artery disease by noninvasive anatomical and functional imaging (2015) Circ Cardiovasc Imaging, 8. , https://doi.org/10.1161/CIRCIMAGING.114.002179; Maffei, E., Seitun, S., Martini, C., Prognostic value of computed tomography coronary angiography in patients with chest pain of suspected cardiac origin [article in English and Polish] (2011) Radiol Med., 116, pp. 690-705; Shaw, L.J., Hausleiter, J., Achenbach, S., Coronary computed tomographic angiography as a gatekeeper to invasive diagnostic and surgical procedures: results from the multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: an International Multicenter) registry (2012) J Am Coll Cardiol., 60, pp. 2103-2114; Nucifora, G., Schuijf, J.D., van Werkhoven, J.M., Prevalence of coronary artery disease across the Framingham risk categories: coronary artery calcium scoring and MSCT coronary angiography (2009) J Nucl Cardiol., 16, pp. 368-375; Motoyama, S., Kondo, T., Sarai, M., Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes (2007) J Am Coll Cardiol., 50, pp. 319-326; Maurovich-Horvat, P., Hoffmann, U., Vorpahl, M., The napkin-ring sign: CT signature of high-risk coronary plaques? (2010) JACC Cardiovasc Imaging., 3, pp. 440-444; Motoyama, S., Ito, H., Sarai, M., Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up (2015) J Am Coll Cardiol., 66, pp. 337-346; Thomsen, C., Abdulla, J., Characteristics of high-risk coronary plaques identified by computed tomographic angiography and associated prognosis: a systematic review and meta-analysis (2016) Eur Heart J Cardiovasc Imaging., 17, pp. 120-129; Guaricci, A.I., Pontone, G., Fusini, L., Additional value of inflammatory biomarkers and carotid artery disease in prediction of significant coronary artery disease as assessed by coronary computed tomography angiography (2017) Eur Heart J Cardiovasc Imaging., 18, pp. 1049-1056; Haffner, S.M., Lehto, S., Rönnemaa, T., Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction (1998) N Engl J Med., 339, pp. 229-234; Maffei, E., Seitun, S., Nieman, K., Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus (2011) Eur Radiol., 21, pp. 944-953; Fox, C.S., Golden, S.H., Anderson, C., Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a Scientific Statement from the American Heart Association and the American Diabetes Association (2015) Diabetes Care., 38, pp. 1777-1803; Rana, J.S., Liu, J.Y., Moffet, H.H., Diabetes and prior coronary heart disease are not necessarily risk equivalent for future coronary heart disease events (2016) J Gen Intern Med., 31, pp. 387-393

PY - 2018

Y1 - 2018

N2 - Background: We sought to evaluate the incremental prognostic benefit of carotid artery disease and subclinical coronary artery disease (CAD) features in addition to clinical evaluation in an asymptomatic population. Methods: Over a 6-year period, 10-year Framingham risk score together with carotid ultrasound and coronary computed tomography angiography were evaluated for prediction of major adverse cardiac events (MACE). Results: We enrolled 517 consecutive asymptomatic patients (63% male, mean age 64 ±10 years; 17.6% with diabetes). Median (interquartile range) coronary artery calcium score (CACS) was 34 (0–100). Over a median follow-up of 4.4 (3.4–5.1) years, there were 53 MACE (10%). Patients experiencing MACE had higher CACS, incidence of carotid disease, presence of CAD ≥50%, and remodeled plaque as compared with 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 predicted MACE (P <0.001). Models adding CAD ≥50% or percentage of segments with remodeled plaque resulted in higher discrimination and reclassification ability compared with a model based on 10-year FRS, carotid disease, and CACS. Specifically, the C-statistic improved to 0.75 with addition of CAD and 0.84 when adding percentage of segments with remodeled plaque, whereas net reclassification improvement indices were 0.86 and 0.92, respectively. Conclusions: In an asymptomatic population, CAD and plaque positive remodeling increase MACE prediction compared with a model based on 10-year FRS, carotid disease, and CACS estimation. In the diabetes subgroup, percentage of segments with remodeled plaque was the only predictor of MACE. © 2018 Wiley Periodicals, Inc.

AB - Background: We sought to evaluate the incremental prognostic benefit of carotid artery disease and subclinical coronary artery disease (CAD) features in addition to clinical evaluation in an asymptomatic population. Methods: Over a 6-year period, 10-year Framingham risk score together with carotid ultrasound and coronary computed tomography angiography were evaluated for prediction of major adverse cardiac events (MACE). Results: We enrolled 517 consecutive asymptomatic patients (63% male, mean age 64 ±10 years; 17.6% with diabetes). Median (interquartile range) coronary artery calcium score (CACS) was 34 (0–100). Over a median follow-up of 4.4 (3.4–5.1) years, there were 53 MACE (10%). Patients experiencing MACE had higher CACS, incidence of carotid disease, presence of CAD ≥50%, and remodeled plaque as compared with 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 predicted MACE (P <0.001). Models adding CAD ≥50% or percentage of segments with remodeled plaque resulted in higher discrimination and reclassification ability compared with a model based on 10-year FRS, carotid disease, and CACS. Specifically, the C-statistic improved to 0.75 with addition of CAD and 0.84 when adding percentage of segments with remodeled plaque, whereas net reclassification improvement indices were 0.86 and 0.92, respectively. Conclusions: In an asymptomatic population, CAD and plaque positive remodeling increase MACE prediction compared with a model based on 10-year FRS, carotid disease, and CACS estimation. In the diabetes subgroup, percentage of segments with remodeled plaque was the only predictor of MACE. © 2018 Wiley Periodicals, Inc.

KW - Calcium Scoring

KW - Cardiovascular Prevention

KW - Carotid Disease

KW - Computed Tomography

KW - Coronary Artery Disease

KW - Diabetes Mellitus

KW - Subclinical Atherosclerosis

KW - adult

KW - Article

KW - carotid atherosclerosis

KW - clinical evaluation

KW - computed tomographic angiography

KW - controlled study

KW - coronary artery atherosclerosis

KW - coronary artery calcium score

KW - diabetes mellitus

KW - female

KW - follow up

KW - Framingham risk score

KW - human

KW - incidence

KW - intravascular ultrasound

KW - major adverse cardiac event

KW - major clinical study

KW - male

KW - prognostic assessment

KW - retrospective study

KW - vascular remodeling

KW - aged

KW - arterial wall thickness

KW - asymptomatic disease

KW - atherosclerotic plaque

KW - blood vessel calcification

KW - carotid artery disease

KW - chi square distribution

KW - coronary angiography

KW - coronary artery disease

KW - diagnostic imaging

KW - Italy

KW - middle aged

KW - multidetector computed tomography

KW - multivariate analysis

KW - procedures

KW - prognosis

KW - proportional hazards model

KW - risk factor

KW - time factor

KW - Aged

KW - Asymptomatic Diseases

KW - Carotid Artery Diseases

KW - Carotid Intima-Media Thickness

KW - Chi-Square Distribution

KW - Computed Tomography Angiography

KW - Coronary Angiography

KW - Female

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Multidetector Computed Tomography

KW - Multivariate Analysis

KW - Plaque, Atherosclerotic

KW - Prognosis

KW - Proportional Hazards Models

KW - Risk Factors

KW - Time Factors

KW - Vascular Calcification

U2 - 10.1002/clc.22952

DO - 10.1002/clc.22952

M3 - Article

VL - 41

SP - 769

EP - 777

JO - Clinical Cardiology

JF - Clinical Cardiology

SN - 0160-9289

IS - 6

ER -