Published Online
on September 13, 2004

A more recent version of this article appeared on September 21, 2004

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Submitted on January 16, 2004
Revised on May 12, 2004
Accepted on May 19, 2004

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, and 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.).

^* To whom correspondence should be addressed. E-mail: von.birgelen{at}freeler.nl.

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

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