Why the study?
Does using a CIMT-derived vascular age in the Framingham Risk Score improve the identification of high-risk patients presenting with a first STEMI?
Does using a CIMT-derived vascular age in the Framingham Risk Score improve the identification of high-risk patients presenting with a first STEMI?
Using CIMT-derived vascular age instead of chronologic age in the Framingham Risk Score significantly improves the identification of first-time STEMI patients as high risk and candidates for statin therapy.
May aid statin eligibility assessment in first STEMI; leaves open prospective confirmation before changing practice.
Patients who suffer a first ST-elevation myocardial infarction (STEMI) typically have fewer identifiable risk factors than those who suffer other types of acute coronary syndromes. As such, risk assessment tools such as the Framingham Risk Score (FRS) often fail to classify these patients as high risk. In this study, we tested the ability of assessment of carotid intima-media thickness (CIMT) to enhance the ability to identify patients who are at risk for STEMI, using a CIMT-derived "vascular age" in place of chronologic age in the calculation of FRS. We applied a CIMT-based vascular age to the assessment of FRS in a cohort of patients who presented with a first STEMI. Using CIMT-derived vascular age in place of chronologic age increased both the mean FRS and predicted 10 year cardiovascular event rate of the cohort. More importantly, the use of a CIMT-derived vascular age in the calculation of FRS significantly improved the ability to identify patients with STEMI as high risk and candidates for statin therapy based on ATPIII criteria (19.2% vs. 57.7%, P = 0.010). The use of CIMT to derive a vascular age may improve the ability of FRS to identify patients at risk for STEMI.
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Kabra et al. (2013) studied this question.
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