Introduction
Limitations of Risk Factor-Based Scores for ASCVD Prediction and Treatment Decision-Making in Primary Prevention
The Evidence for Atherosclerosis Imaging to Improve ASCVD Risk Assessment and Primary Prevention
Coronary Artery Calcium Scoring
Prognostic Accuracy of Coronary Artery Calcium Scoring
First author [Ref. #] | N | Mean age (years) | Follow-up (years) | Agatston calcium score cutoff | Comparator group for relative risk calculation | Relative risk ratio |
---|---|---|---|---|---|---|
Arad et al. [9] | 1173 | 53 | 3.6 | >160 | <160 | 20.2 |
Wong et al. [63] | 926 | 54 | 3.3 | Top quartile (>270) | First quartile | 8.8 |
Greenland et al. [16] | 1312 | 66 | 7.0 | >300 | No CAC | 3.9 |
Shaw et al. [46•] | 10,377 | 53 | 5 | ≥400 | ≤10 | 8.4 |
Arad et al. [34] | 5585 | 59 | 4.3 | ≥100 | <100 | 10.7 |
Taylor et al. [12] | 2000 | 40–50 | 3.0 | >44 | 0 | 11.8 |
Vliegenthart et al. [64] | 1795 | 71 | 3.3 | >1000 | <100 | 8.3 |
400–1000 | <100 | 4.6 | ||||
Budoff et al. [46•] | 25,503 | 56 | 6.8 | >400 | 0 | 9.2 |
Lakoski et al. [65] | 3601 | 45–84 | 3.75 | >0 | 0 | 6.5 |
Becker et al. [66] | 1726 | 57.7 | 3.4 | >400 | 0 | 6.8 men |
7.9 women | ||||||
Detrano et al. [10] | 6814 | 62.2 | 3.8 | >300 | 0 | 14.1 |
Erbel et al. [26] | 4487 | 45–75 | 5 | >75th percentile | <25th percentile | 11.1 men |
3.2 women |
Power of Zero and Impact of CAC on Cost, Treatment, and Outcomes
The Evidence for Atherosclerosis Imaging to Improve ASCVD Risk Assessment and Primary Prevention
Carotid Intima-Media Thickness and Plaque Screening
Prognostic Accuracy of CIMT and Plaque by Carotid Ultrasound
Study [Reference #] | Sample Size | Age of Subjects | Follow-up | Carotid Ultrasound Parameters | Plaque | Endpoints | CIMT, RR (95% CI) | NRI |
---|---|---|---|---|---|---|---|---|
APSIS [67] | 558 | 60 + 7 yrs | Median, 3.0 yrs | Max left CCA-IMT, far wall | Not specified | CV death, MI, revascularization | IMT>1.02mm, RR: 0.78 (0.36-1.70) for CV death or MI; RR: 1.07 (0.56-2.04) for revascularization | |
ARIC [68] | 12,841 | 45-64 yrs | Mean follow-up 15.1 yrs | Mean far wall IMT at 6 sites (CCA, bulb, ICA, bilateral) | Plaque included | MI, CV death | IMT > 1.0mm: women HR: 5.07 (3.08-8.36); men 1.85 (1.28-2.69) | 7.1 |
CAPS [69] | 5,056 | 19-90yrs | Mean follow-up 4.2 yrs | Mean far wall IMT bilaterally at CCA, carotid BIF, ICA bulb | Not specified | MI, stroke, death | RR for 1 SD: RR 1.17(1.08-1.26) for CCA-IMT; RR 1.14 (1.05-1.24), for carotid bulb-IMT; RR 1.09 (1.01-1.18) for ICA-IMT. | -1.4 |
CCCC [70] | 2,190 | > 35 yrs | Median, 10.5 yrs | Maximal CCA-IMT, far wall, bilateral | Plaque excluded | MI, CV death, PCI, CABG | RR: 1SD; 1.38 (1.12-1.70) | |
Charlottesville Study [71] | 727 | 16-85 yrs | Mean, 4.78 yrs | Mean CCA-IMT, bulb-IMT, ICA-IMT, near and far wall bilaterally | Plaque included | MI, revascularization, stroke, TIA | OR for highest quartile of carotid bulb IMT: 5.8 (1.3-26.6) | |
CHS [72] | 5,020 | 72.6+5.5 yrs | 5 days to 12 yrs (median, 11 yrs) | CCA and ICA-IMT, mean of maximal IMT, near and far wall bilaterally | Plaque included | MI, stroke, CV death, all-cause mortality | Highest tertile: RR: 1.84 (1.54-2.20) | |
Cournot, et al. [73] | 2,561 | 51.6 + 10.5 yrs | 2-10 yrs | CCA-IMT, ICA-IMT bilaterally | Plaque excluded | CV death, MI, angina | IMT >0.63mm; HR: 2.26 (1.35-3.79) | |
FATE [74] | 1,574 | 49.4 + 9.9yrs | Mean, 7.2 yrs | Right CCA-IMT | Plaque excluded | CV death, revacularization, MI, angina, stroke | HR: 1.45 (1.15-1.83) | 11.6% |
Framingham Offspring Study [75] | 2,965 | 58 + 10yrs | Average, 7.2yrs | Mean CCA-IMT, or maximal CCA-IMT, maximal ICA-IMT, bilaterally | Plaque excluded | MI, angina, CV death, stroke, claudication, heart failure | HR for 1-SD mean CCA-IMT: 1.13 (1.02-1.24); HR for 1-SD maximal CCA-IMT: 1.21 (1.13-1.29); HR for 1-SD maximal ICA-IMT: 1.21 (1.13-1.29) | CCA: O% ICA: 7.6% |
IMPROVE [76] | 3,703 | Median 64.4yrs | Median 36.2 months | Maximal and mean CCA, ICA, BIF, bilaterally | Plaque included | MI, SCD, angina, stoke, TIA, heart failure, revascularization | HR for 1-SD increase: mean CCA-IMT: 1.33 (1.18-1.50); mean BIF-IMT: 1.28 (1.12-1.47); mean ICA-IMT: 1.34 (1.18-1.51) | FRF+ICCAD+IMT mean-max 12.1% |
KIHD [77] | 1,257 | 42-60 yrs | 1 mo- 2.5yrs | CCA-IMT, mean of max IMT, near and far wall bilaterally | Focal calcified plaque not included | AMI | CCA-IMT increment, 0.1mm; RR: 2.14 (1.08-4.26) | |
LILAC [78] | 298 | Mean, 79.6yrs | Mean 1,152 days | Average of CCA bilaterally, near and fall wall | Not specified | All-cause mortality | For 0.3mm increase in left IMT, RR: 1.65 (1.08-2.5); right IMT, RR: 3.3 (1.4-1.7) | |
MESA [20] | 6,814 | 45-84 yrs | Median, 7.6yrs | Mean of max right CCA-IMT, far wall | Plaque excluded | MI, revascularization, SCD, CV death | HR: 1.17 (0.95-1.45) | Mean-max IMT 7.0% Max-IMT 6.8% |
MDCS [79] | 5,163 | 46-68 yrs | Median 7yrs | Mean far wall right distal CCA | Plaque included | MI, CV death | RR for highest tertile: 1.50 (0.81-2.59) | |
OSACA2 [80] | 574 | 65.3 + 9.5yrs | Mean, 2.6yrs | Mean maximal CCA-IMT, BIF-IMT, ICA-IMT, near and far wall bilaterally | Plaque included | MI, CABG, angioplasty, PAD, stroke | For 1-SD increase, RR: 1.57 (1.11-2.20) | |
Rotterdam Study [81] | 6.389 | 69.3 + 9.2 yrs | 7-10 years | Avg of max CCA-IMT or near and far wall bilaterally | Not specified | MI | RR: 1.95 (1.19-3.19) | CAD, Stroke Men: 0.2, 3.9 Women: 8.2, 8.0 |
The Edinburg Artery Study [82] | 1,007 | Mean 69.4 yrs | 12 years | Max far wall CCA-IMT bilaterally | Not specified | MI, stroke, angina, claudication | IMT > 0.9mm, OR: 1.59 (1.07-2.37) | |
Three-City Study [83] | 5,895 | 65-85 yrs | Median 5.4yrs | Mean CCA-IMT bilaterally, near and far wall | Plaque measured separately | MI, angina, CV death, revascularization | HR for fifth quintile: 0.8 (0.5-1.2) | Carotid plaque 13.7% |
Tromso Study [84] | 6,226 | 25-84yrs | 6 years | Mean of near and far wall right CCA-IMT and far wall of the bulb | Plaque included | MI | Highest IMT quartile, 1.73 (0.98-3.06) in men and 2.86 (1.07-7.65) in women |