title: Associations between the Framingham Risk Score and coronary plaque characteristics as assessed by three-vessel optical coherence tomography.
abstract: OBJECTIVE
  This study sought to explore the association between the Framingham Risk Score (FRS) and coronary plaque characteristics assessed by optical coherence tomography (OCT) imaging.
  
  
  BACKGROUND
  Clinical prediction models are useful for identifying high-risk patients. However, coronary events often occur in individuals estimated to be at low risk.
  
  
  METHODS
  A total of 254 patients with coronary artery disease who underwent three-vessel OCT were divided into tertiles according to FRS. Nonculprit plaque characteristics were compared among the three groups.
  
  
  RESULTS
  A total of 663 plaques were analyzed. FRS was significantly associated with calcification [37% (low FRS) vs. 46% (intermediate FRS) vs. 70% (high FRS); P<0.001] and neovascularization [39% (low FRS) vs. 41% (intermediate FRS) vs. 56% (high FRS); P<0.001], but not with lipid-rich plaques or thin-cap fibroatheroma (TCFA). On multivariate analysis, FRS was an independent predictor of the presence of both calcification and neovascularization. There were no deaths, two acute myocardial infarctions, and 15 nontarget lesion revascularizations at the 1-year follow-up. The event rate increased progressively across FRS tertiles [2.4% (low FRS) vs. 7.1% (intermediate FRS) vs. 8.6% (high FRS); P=0.186]. The c-statistic for FRS to predict future clinical events was 0.628 (95% confidence interval, 0.500-0.757). The addition of both calcification and TCFA to FRS provided incremental prognostic value [c-statistics: 0.761 (95% confidence interval, 0.631-0.890)].
  
  
  CONCLUSIONS
  The present study showed significant associations between FRS and the presence of coronary calcification and neovascularization in nonculprit plaques. The combination of FRS and OCT-detected calcifications and TCFA provides improved prognostic ability in identifying patients with known coronary artery disease who are at risk of recurrent events.
authors.affiliation: aCardiology Division bBiostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston cNational Heart, Lung, and Blood Institute, The Framingham Heart Study, Framingham, Massachusetts, USA dDepartment of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China eCardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo fDepartment of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy gDepartment of Cardiology, Nara Medical University, Nara, Japan hDivision of Cardiology, Kyung Hee University, Seoul, South Korea.
authors.forename: Rocco
authors.initials: R
authors.lastname: Vergallo
authors.forename: Lei
authors.initials: L
authors.lastname: Xing
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ong
authors.forename: Lei
authors.initials: L
authors.lastname: Gao
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Biasucci
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.forename: Shiro
authors.initials: S
authors.lastname: Uemura
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Donnell
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D009389:Neovascularization, Pathologic; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D041623:Tomography, Optical Coherence; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000473:pathology