This Article Full Text Full Text (PDF) All Versions of this Article: 110/12/1579    most recent 01.CIR.0000142048.94084.CAv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by von Birgelen, C. Articles by Erbel, R. Search for Related Content PubMed PubMed Citation Articles by von Birgelen, C. Articles by Erbel, R. Related Collections Platelet function inhibitors Catheter-based coronary interventions: stents Acute myocardial infarction

(Circulation. 2004;110:1579-1585.)
© 2004 American Heart Association, Inc.

Coronary Heart Disease

Relationship Between Cardiovascular Risk as Predicted by Established Risk Scores Versus Plaque Progression as Measured by Serial Intravascular Ultrasound in Left Main Coronary Arteries

Clemens von Birgelen, MD, PhD; Marc Hartmann, MD; Gary S. Mintz, MD; K. Gert van Houwelingen, MD; Nadine Deppermann, MD; Axel Schmermund, MD; Dirk Böse, MD; Holger Eggebrecht, MD; Till Neumann, MD; Mario Gössl, MD; Heinrich Wieneke, MD; Raimund Erbel, MD

From Essen University, Department of Cardiology, Essen, Germany (M.H., N.D., A.S., D.B., H.E., T.N., M.G., H.W., R.E.); Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands (C.B., K.G.H.); and the Cardiovascular Research Foundation, New York, NY (G.S.M.).

Correspondence to Clemens von Birgelen, MD, PhD, Thoraxcentrum Twente, Hospital Enschede, Department of Cardiology, Medisch Spectrum Twente, Haaksbergerstr. 55, 7513ER Enschede, The Netherlands. E-mail von.birgelen{at}freeler.nl

Received January 16, 2004; de novo received February 26, 2004; revision received May 12, 2004; accepted May 19, 2004.

Background— Intravascular ultrasound (IVUS) is increasingly used as an end point in studies aimed at reducing progression or inducing regression of coronary artery disease. However, data linking serial changes by IVUS with clinical outcomes are scarce.

Methods and Results— In the absence of a validated risk score for secondary prevention, we compared 3 established risk scores for primary prevention—PROCAM, SCORE, and Framingham—with plaque progression and lumen reduction as assessed with serial IVUS (follow-up, 18±9 months) in atherosclerotic left main coronary arteries of 56 patients with established atherosclerosis. For all 3 algorithms, patients at highest estimated risk of events showed greater plaque progression than patients at lowest risk (P<0.05 to <0.01). There were positive linear relationships between the risk of clinical events and plaque progression (r=0.41 to 0.60; P<0.002 to <0.0001). This translated into a greater decrease in lumen dimensions with increasing risk (P<0.05, PROCAM and SCORE). Risk prediction using the PROCAM algorithm showed the strongest relation with serial IVUS. During follow-up, 18 patients suffered from adverse cardiovascular events; these patients had an annual plaque progression that was significantly greater than other patients (25.2±19.4% versus 5.9±15.6%, P<0.001).

Conclusions— There was a positive linear relationship between the estimated risk of clinical events derived from all 3 established risk-score algorithms and the extent of plaque progression measured by serial IVUS. This translated into stenosis progression (reduction in lumen dimensions) with increasing clinical risk.

Key Words: coronary disease • risk • ultrasonics • imaging • prevention, secondary

This article has been cited by other articles:

				S. J. Nicholls, E. M. Tuzcu, S. Kalidindi, K. Wolski, K.-W. Moon, I. Sipahi, P. Schoenhagen, and S. E. Nissen Effect of Diabetes on Progression of Coronary Atherosclerosis and Arterial Remodeling: A Pooled Analysis of 5 Intravascular Ultrasound Trials J. Am. Coll. Cardiol., July 22, 2008; 52(4): 255 - 262. [Abstract] [Full Text] [PDF]

				S. H. Han, J. H. Bae, D. R. Holmes Jr, R. J. Lennon, E. Eeckhout, G. W. Barsness, C. S. Rihal, and A. Lerman Sex differences in atheroma burden and endothelial function in patients with early coronary atherosclerosis Eur. Heart J., June 1, 2008; 29(11): 1359 - 1369. [Abstract] [Full Text] [PDF]

				J. J.P. Kastelein and E. de Groot Ultrasound imaging techniques for the evaluation of cardiovascular therapies Eur. Heart J., April 1, 2008; 29(7): 849 - 858. [Abstract] [Full Text] [PDF]

				B. G. Brown A Direct Comparison of Intravascular Ultrasound and Quantitative Coronary Arteriography: Implications for Measures of Atherosclerosis as Clinical Surrogates Circulation, April 10, 2007; 115(14): 1824 - 1826. [Full Text] [PDF]

				C. von Birgelen and M. Hartmann Coronary Plaque Burden and Cardiovascular Risk Factors: Single-Point Versus Serial Assessment J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1914 - 1915. [Full Text] [PDF]

				M. Hartmann, C. von Birgelen, G. S. Mintz, M. G. Stoel, H. Eggebrecht, H. Wieneke, M. Fahy, T. Neumann, J. van der Palen, H. W. Louwerenburg, et al. Relation Between Lipoprotein(a) and Fibrinogen and Serial Intravascular Ultrasound Plaque Progression in Left Main Coronary Arteries J. Am. Coll. Cardiol., August 1, 2006; 48(3): 446 - 452. [Abstract] [Full Text] [PDF]

				M. Hartmann, C. von Birgelen, G. S. Mintz, P. M.J. Verhorst, and R. Erbel Relation between baseline plaque burden and subsequent remodelling of atherosclerotic left main coronary arteries: a serial intravascular ultrasound study with long-term (>=12 months) follow-up Eur. Heart J., August 1, 2006; 27(15): 1778 - 1784. [Abstract] [Full Text] [PDF]

				J.-C. Tardif, T. Heinonen, D. Orloff, and P. Libby Vascular Biomarkers and Surrogates in Cardiovascular Disease Circulation, June 27, 2006; 113(25): 2936 - 2942. [Abstract] [Full Text] [PDF]

				S. J. Nicholls, E. M. Tuzcu, T. Crowe, I. Sipahi, P. Schoenhagen, S. Kapadia, S. L. Hazen, C.-C. Wun, M. Norton, F. Ntanios, et al. Relationship Between Cardiovascular Risk Factors and Atherosclerotic Disease Burden Measured by Intravascular Ultrasound J. Am. Coll. Cardiol., May 16, 2006; 47(10): 1967 - 1975. [Abstract] [Full Text] [PDF]

				C. von Birgelen, M. Hartmann, G. S. Mintz, D. Bose, H. Eggebrecht, T. Neumann, M. Gossl, H. Wieneke, A. Schmermund, M. G. Stoel, et al. Remodeling Index Compared to Actual Vascular Remodeling in Atherosclerotic Left Main Coronary Arteries as Assessed With Long-Term (>=12 Months) Serial Intravascular Ultrasound J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1363 - 1368. [Abstract] [Full Text] [PDF]

				K. Leineweber, D. Bose, M. Vogelsang, M. Haude, R. Erbel, and G. Heusch Intense Vasoconstriction in Response to Aspirate From Stented Saphenous Vein Aortocoronary Bypass Grafts J. Am. Coll. Cardiol., March 7, 2006; 47(5): 981 - 986. [Abstract] [Full Text] [PDF]

				A. Schmermund, S. Achenbach, T. Budde, Y. Buziashvili, A. Forster, G. Friedrich, M. Henein, G. Kerkhoff, F. Knollmann, V. Kukharchuk, et al. Effect of Intensive Versus Standard Lipid-Lowering Treatment With Atorvastatin on the Progression of Calcified Coronary Atherosclerosis Over 12 Months: A Multicenter, Randomized, Double-Blind Trial Circulation, January 24, 2006; 113(3): 427 - 437. [Abstract] [Full Text] [PDF]