Evaluating of the accurasy of cardiovascular events predicting using SCORE scale and ultrasound visualization of atherosclerotic plaque in patients of multi-disciplinary hospital in Saint-Petersburg: medium-term monitoring data

Aim. To compare the accuracy of predicting the risk of fatal and non-fatal cardiovascular events (CVE) based on SCORE scaling and ultrasound imaging of carotid atherosclerotic plaque (AP) in patients without manifested atherosclerotic cardiovascular disease (ACVD) in a multidisciplinary hospital.

Material and methods. We examined 841 patients (353 men) (avearage age 54,9±8), with at least 1 traditional cardiovascular risk factor without manifested ACVD. Ultrasound examination of the carotid arteries was performed in all patients. Patients with nonstenotic AP constituted the AP+ group, and without AP — the AP-group (356 and 485 people, respectively). Median of follow-up time was 4 years, (minimum — 2, maximum — 6 years). The endpoints included: a verified diagnosis of acute coronary syndrome, chronic coronary artery disease, planned coronary revascularization, ischemic stroke, and/or transient ischemic attack, cardiac death.

Results. Nonstenotic AP of carotid arteries was detected in 352 people (42%), including 64 (23%) in low and 182 (46%) in moderate SCORE risk. 127 CVE (178%) occurred during the follow-up, 84 (66% of the total) of them in the AP+ group. The actual frequency of development of the cumulative endpoint was significantly higher than the calculated rate (the ratio of actua predicted events was 1,6, 5,1 and 79 for high, moderate and low SCORE risk, respectively). According to the multivariate regression analysis, the OR for AP as a predictor of cardiovascular events cardiovascular events CVE was 2,54 (95% CI 1,6-4,04), and was significantly higher than the SCORE index (1,04, 95% CI 0,01-1,07). As a predictor of CVE, AP had the greatest value in the low SCORE risk group (the number of CVE in the low SCORE risk group was14 among patients with AP vs 10 among patients without AP, p=0,001).

Conclusion. The use of SCORE scale underestimates the actual risk of CVE especially in patients with low and moderate calculated SCORE risk. Ultrasound visualization of AP of the carotid arteries in these patients predicts the risk of cardiovascular disease much more accurately.

1. Cardiovascular prevention 2017. National Guidelines. Russian Journal of Cardiology. 2018; (6):7-122. (In Russ.) doi:10.15829/1560-4071-2018-6-7-122.

2. Ajani UA, Ford ES. Has the risk for coronary heart disease changed among US adults. JACC. 2006;48 (6):1177-82. doi:10.1016/j.jacc.2006.05.055.

3. Roman MJ, Naqvi TZ, Gardin JM, et al. Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification: a report from the American Society of Echocardiography and the Society for Vascular Medicine and Biology. American Society of Echocardiography Report. Vasc. Med. 2006;19 (8):201-11. doi:10.1177/1358863x06070511.

4. Katamadze NO, Berstein LL, Grishkin YuN. Subclinical atherosclerosis imaging as a component of a comprehensive strategy for cardiovascular risk stratification. Cardiovascular Therapy and Prevention. 2012;2:76-84. (In Russ.)

5. Vlachopoulos C, Xaplanteris P, Aboyans V, et al. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society. Atherosclerosis. 2015;241 (2):507-32. doi:10.1016/j.atherosclerosis.2015.05.007.

6. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). The Lancet. 1998;351 (9113):1379-87

7. Muromtseva G. A., Kontsevaya A. V., Konstantinov V. V. The prevalence of non-infectious diseases risk factors in Russian population in 2012-2013 years. The results of ECVD-RF. Cardiovascular Therapy and Prevention. 2014; 13 (6):4-11. (In Russ.) doi:1015829/1728-8800-2014-6-4-11.

8. Halcox JP, Banegas JR, Roy С, et al. Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe: EURIKA, a cross-sectional observational study. BMC Cardiovasc. Disord. 2017;17 (1):160. doi:10.1186/s12872-017-0591-5.

9. Boytsov SA, Kukharchuk VV, Karpov YA, et al. Subclinical atherosclerosis as a risk factor of cardiovascular complications. Cardiovascular Therapy and Prevention. 2012;11 (3):82-6. (In Russ.)

10. Zhernakova YuV, Kaveshnikov VS, Serebriakova VN, et al. The prevalence of carotid atherosclerosis in spontaneous populations in Tomsk. Systemic hypertension. 2014;11 (4):37-42. (In Russ.)

11. Diagnostics and correction of lipid metabolism disorders in order to prevent and treat atherosclerosis. Russian recommendations VI revision. Journal of Atherosclerosis and Dyslipidaemias. 2017;28 (3):5-23. (In Russ.)

12. Vikhireva O, Pjk A, Broda G, et al. SCORE performance in Central and Eastern Europe and former Soviet Union: MONICA and HAPIEE results. Eur. Heart J. 2014;35 (9):571-7 doi:10.1093/eurheartj/eht189.

13. Taylor AJ, Bindeman J, Feuerstein IJ, et al. Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project. Am. Coll. Cardiol. 2005;46 (5):807-14. doi:10.1089/met.2012.0165.

14. Golovina AE, Katamadze NO, Bondareva EV, et al. The role of ultrasound imaging of subclinical carotid atherosclerosis in predicting of cardiovascular risk in primary prevention of cardiovascular diseases. Journal of Atherosclerosis and Dyslipidaemias. 2017;1 (26):5-16. (In Russ.)

15. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur. Heart J. 2016;37 (29):2315-81. doi:10.1093/eurheartj/ehw106.

16. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur. Heart J. 2013;31 (7):2159-219. doi:10.1097/01.hjh.0000431740.32696.cc.