A simplified approach for prediction of stroke risk in asymptomatic carotid atherosclerosis

Background Ischemic cardiovascular diseases are leading global causes of death, largely driven by atherosclerosis. Purpose To develop a simplified approach to enhance the predictive accuracy of the revised Framingham Stroke Risk Profile (rFSRP) by integrating ultrasound-derived plaque characteristics. Material and Methods The study population consisted of 1782 asymptomatic patients with carotid plaques, prospectively enrolled from three hospitals. The patients were stratified into high-risk and low-risk groups using both the conventional rFSRP and a novel approach incorporating ultrasonic plaque features. Kaplan–Meier survival analysis and log-rank tests were utilized to evaluate stroke-free survival rates. Results Over a mean follow-up of 37 ± 15 months, 420 (23.5%) patients experienced strokes. Both univariate and multivariate analyses demonstrated a significant association between strokes and various parameters: an rFSRP score ≥10, plaque length ≥10 mm, plaque thickness ≥2 mm, and the presence of type 1 and type 2 plaque according to the Geroulakos classification. A notable disparity in stroke-free survival rate was observed between high-risk and low-risk groups when classified using the combined criteria of rFSRP and ultrasonic features ( P <0.001). The net reclassification improvement formula, accounting for reclassification accuracy, indicated that 11.2% of patients were more precisely classified under the combined criteria. In addition, patients initially deemed low-risk based solely on rFSRP, when reclassified as high-risk per the combined criteria, showed a substantial difference in stroke-free survival rate from those remaining in the low-risk category ( P <0.001). Conclusion Integrating ultrasound-derived plaque characteristics with rFSRP improves stroke risk prediction, offering a more effective clinical tool for asymptomatic carotid atherosclerosis.