Coronary Risk Stratification, Discrimination, and Reclassification Improvement Based on Quantification of Subclinical Coronary Atherosclerosis
| Autor: | Martina Bröcker-Preuss, Klaus Mann, Rainer Seibel, Raimund Erbel, Nils Lehmann, Dietrich Grönemeyer, Nico Dragano, Andreas Stang, Susanne Moebus, Axel Schmermund, Stefan Möhlenkamp, Johannes Siegrist, Hagen Kälsch, Karl-Heinz Jöckel |
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| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
Framingham Risk Score business.industry medicine.disease Asymptomatic Coronary artery disease Internal medicine medicine Cardiology Myocardial infarction Myocardial infarction diagnosis medicine.symptom Cardiology and Cardiovascular Medicine business Risk assessment Coronary atherosclerosis Cohort study |
| Zdroj: | Journal of the American College of Cardiology. 56:1397-1406 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2010.06.030 |
| Popis: | Objectives The purpose of this study was to determine net reclassification improvement (NRI) and improved risk prediction based on coronary artery calcification (CAC) scoring in comparison with traditional risk factors. Background CAC as a sign of subclinical coronary atherosclerosis can noninvasively be detected by CT and has been suggested to predict coronary events. Methods In 4,129 subjects from the HNR (Heinz Nixdorf Recall) study (age 45 to 75 years, 53% female) without overt coronary artery disease at baseline, traditional risk factors and CAC scores were measured. Their risk was categorized into low, intermediate, and high according to the Framingham Risk Score (FRS) and National Cholesterol Education Panel Adult Treatment Panel (ATP) III guidelines, and the reclassification rate based on CAC results was calculated. Results After 5 years of follow-up, 93 coronary deaths and nonfatal myocardial infarctions occurred (cumulative risk 2.3%; 95% confidence interval: 1.8% to 2.8%). Reclassifying intermediate (defined as 10% to 20% and 6% to 20%) risk subjects with CAC Conclusions CAC scoring results in a high reclassification rate in the intermediate-risk cohort, demonstrating the benefit of imaging of subclinical coronary atherosclerosis. Our study supports its application, especially in carefully selected individuals with intermediate risk. |
| Databáze: | OpenAIRE |
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