Open AccessPrognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and nondiabetic asymptomatic population
Author(s) -
Guaricci Andrea Igoren,
Lorenzoni Valentina,
Guglielmo Marco,
Mushtaq Saima,
Muscogiuri Giuseppe,
Cademartiri Filippo,
Rabbat Mark,
Andreini Daniele,
Serviddio Gaetano,
Gaibazzi Nicola,
Pepi Mauro,
Pontone Gianluca
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22952
Subject(s) - medicine , mace , coronary artery disease , asymptomatic , cardiology , interquartile range , population , subclinical infection , diabetes mellitus , myocardial infarction , percutaneous coronary intervention , endocrinology , environmental health
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.