Prediction of Severe Baseline Asymptomatic Carotid Stenosis and Subsequent Risk of Stroke and Cardiovascular Disease.

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY Stroke Pub Date : 2024-11-01 Epub Date: 2024-09-25 DOI:10.1161/STROKEAHA.123.046894

Michiel H F Poorthuis, Steven H J Hageman, Aernoud T L Fiolet, L Jaap Kappelle, Michiel L Bots, Ph Gabriel Steg, Frank L J Visseren, Deepak L Bhatt, Gert J de Borst

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Abstract

Background: Risk models to identify patients at high risk of asymptomatic carotid artery stenosis (ACAS) can help in selecting patients for screening, but long-term outcomes in these patients are unknown. We assessed the diagnostic and prognostic value of the previously published Prevalence of ACAS (PACAS) risk model to detect ACAS at baseline and to predict subsequent risk of stroke and cardiovascular disease (CVD) during follow-up.

Methods: We validated the discrimination and calibration of the PACAS risk model to detect severe (≥70% narrowing) ACAS with patients from the Reduction of Atherothrombosis for Continued Health registry. We subsequently calculated the incidence rates of stroke and CVD (fatal and nonfatal stroke or myocardial infarction or vascular death) during follow-up in 4 risk groups (low, medium, high, and very high, corresponding to sum scores of ≤9, 10-13, 14-17, and ≥18, respectively).

Results: Among 26 384 patients, aged between 45 and 80 years, without prior carotid procedures, 1662 (6.3%) had severe baseline ACAS. During ≈70 000 patient-years of follow-up, 1124 strokes and 2484 CVD events occurred. Discrimination of the PACAS model was 0.67 (95% CI, 0.65-0.68), and calibration showed adequate concordance between predicted and observed risks of severe baseline ACAS after recalibration. Significantly higher incidence rates of stroke (P_trend<0.011) and CVD (P_trend<0.0001) during follow-up were found with increasing PACAS risk groups. Among patients with high PACAS sum score of ≥14 (corresponding to 27.7% of all patients), severe baseline ACAS prevalence was 11.4%. In addition, 56.6% of incident strokes and 64.9% of incident CVD events occurred in this group.

Conclusions: The PACAS risk model can reliably identify patients at high risk of severe baseline ACAS. Incidence rates of stroke and CVD during follow-up were significantly higher in patients with high PACAS sum scores. Selective screening of patients with high PACAS sum scores may help to prevent future stroke or CVD.

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严重基线无症状颈动脉狭窄与中风和心血管疾病后续风险的预测。

背景：识别无症状颈动脉狭窄（ACAS）高风险患者的风险模型有助于选择接受筛查的患者，但这些患者的长期预后尚不清楚。我们评估了之前发表的 ACAS 流行率（PACAS）风险模型的诊断和预后价值，以检测基线 ACAS 并预测随访期间中风和心血管疾病（CVD）的后续风险：我们利用 "减少动脉粥样硬化血栓形成，促进持续健康 "登记处的患者验证了 PACAS 风险模型检测严重（≥ 70% 狭窄）ACAS 的辨别力和校准能力。随后，我们计算了 4 个风险组（低、中、高和极高，分别对应总分≤9、10-13、14-17 和≥18）随访期间中风和心血管疾病（致死性和非致死性中风或心肌梗死或血管性死亡）的发病率：在 26 384 名年龄在 45 至 80 岁之间、未接受过颈动脉手术的患者中，有 1662 人（6.3%）的基线 ACAS 为重度。在≈70 000患者年的随访期间，共发生了1124起脑卒中和2484起心血管疾病事件。PACAS模型的识别率为0.67（95% CI，0.65-0.68），校准结果显示，经过重新校准后，严重基线ACAS的预测风险与观察风险之间有足够的一致性。脑卒中发病率显著升高（PtrendPtrendConclusions：PACAS 风险模型可以可靠地识别严重基线 ACAS 的高风险患者。在随访期间，PACAS 总分高的患者中风和心血管疾病的发病率明显更高。对 PACAS 总分高的患者进行选择性筛查可能有助于预防未来的中风或心血管疾病。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.