Carotid intima-media thickness assessment in refinement of the Framingham Risk Score: can it predict ST-elevation myocardial infarction? A pilot study.
Patients who suffer a first ST-elevation myocardial infarction (STEMI) typically have fewer identifiable risk factors than those who suffer other types of acute coronary syndromes. As such, risk assessment tools such as the Framingham Risk Score (FRS) often fail to classify these patients as high risk. In this study, we tested the ability of assessment of carotid intima-media thickness (CIMT) to enhance the ability to identify patients who are at risk for STEMI, using a CIMT-derived "vascular age" in place of chronologic age in the calculation of FRS. We applied a CIMT-based vascular age to the assessment of FRS in a cohort of patients who presented with a first STEMI. Using CIMT-derived vascular age in place of chronologic age increased both the mean FRS and predicted 10 year cardiovascular event rate of the cohort. More importantly, the use of a CIMT-derived vascular age in the calculation of FRS significantly improved the ability to identify patients with STEMI as high risk and candidates for statin therapy based on ATPIII criteria (19.2% vs. 57.7%, P = 0.010). The use of CIMT to derive a vascular age may improve the ability of FRS to identify patients at risk for STEMI.
Cardiovascular Research Institute, Lehigh Valley Health Network, Allentown, Pennsylvania.
Ash
A
Kabra
Lori
L
Neri
Hillel
H
Weiner
Yasser
Y
Khalil
Martin E
ME
Matsumura
D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D018570:Risk Assessment / Q000379:methods
carotid artery; ultrasound imaging; vascular imaging