Most of the patients presenting myocardial infarction would not be eligible for intensive lipid-lowering based on clinical algorithms or plasma C-reactive protein.
OBJECTIVE
The study we assessed how often patients who are manifesting a myocardial infarction (MI) would not be considered candidates for intensive lipid-lowering therapy based on the current guidelines.


METHODS
In 355 consecutive patients manifesting ST elevation MI (STEMI), admission plasma C-reactive protein (CRP) was measured and Framingham risk score (FRS), PROCAM risk score, Reynolds risk score, ASSIGN risk score, QRISK, and SCORE algorithms were applied. Cardiac computed tomography and carotid ultrasound were performed to assess the coronary artery calcium score (CAC), carotid intima-media thickness (cIMT) and the presence of carotid plaques.


RESULTS
Less than 50% of STEMI patients would be identified as having high risk before the event by any of these algorithms. With the exception of FRS (9%), all other algorithms would assign low risk to about half of the enrolled patients. Plasma CRP was <1.0mg/L in 70% and >2mg/L in 14% of the patients. The average cIMT was 0.8±0.2mm and only in 24% of patients was ≥1.0mm. Carotid plaques were found in 74% of patients. CAC ≥100 was found in 66% of patients. Adding CAC ≥100 plus the presence of carotid plaque, a high-risk condition would be identified in 100% of the patients using any of the above mentioned algorithms.


CONCLUSIONS
More than half of patients manifesting STEMI would not be considered as candidates for intensive preventive therapy by the current clinical algorithms. The addition of anatomical parameters such as CAC and the presence of carotid plaques can substantially reduce the CVD risk underestimation.
Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil. dclandrei@yahoo.com
Andrei C
AC
Sposito
Bruno Farah
BF
Alvarenga
Alison S
AS
Alexandre
Ana Laura Ribeiro
AL
Araújo
Simone N
SN
Santos
Joalbo M
JM
Andrade
Jose A F
JA
Ramires
Jose C
JC
Quinaglia E Silva
Otavio Rizzi
OR
Coelho
D000368:Aged; D000465:Algorithms; D002097:C-Reactive Protein / Q000096:biosynthesis*; D002118:Calcium / Q000378:metabolism; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000378:metabolism*; D012306:Risk; D014057:Tomography, X-Ray Computed / Q000379:methods; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D014463:Ultrasonography / Q000379:methods
D002097:C-Reactive Protein; D002118:Calcium