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Most of the patients presenting myocardial infarction would not be eligible for intensive lipid-lowering based on
Andrei C Sposito1, Bruno Farah Alvarenga, Alison S Alexandre
1Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil. dclandrei@yahoo.com
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Current risk algorithms fail to identify many ST-elevation myocardial infarction (STEMI) patients for intensive lipid-lowering therapy. Adding anatomical measures like coronary artery calcium (CAC) and carotid plaques improves risk assessment for cardiovascular disease (CVD).
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Current cardiovascular disease (CVD) risk algorithms often underestimate risk in patients experiencing myocardial infarction (MI).
- Guidelines for intensive lipid-lowering therapy may exclude a significant number of high-risk individuals.
- Accurate risk stratification is crucial for effective preventive strategies.
Purpose of the Study:
- To evaluate the effectiveness of existing risk scores in identifying ST-elevation MI (STEMI) patients eligible for intensive lipid-lowering therapy.
- To determine if anatomical imaging markers can improve CVD risk assessment in STEMI patients.
Main Methods:
- Assessed 355 STEMI patients using Framingham, PROCAM, Reynolds, ASSIGN, QRISK, and SCORE algorithms.
- Measured admission C-reactive protein (CRP).
- Utilized cardiac computed tomography for coronary artery calcium (CAC) scoring and carotid ultrasound for intima-media thickness (cIMT) and plaque assessment.
Main Results:
- Less than 50% of STEMI patients were identified as high-risk by traditional algorithms prior to their event.
- Traditional risk scores, except Framingham, assigned low risk to approximately half of the patients.
- Combining CAC score (≥100) and carotid plaques identified 100% of patients as high-risk, regardless of the algorithm used.
Conclusions:
- Over half of STEMI patients are inadequately assessed for intensive preventive therapy by current clinical algorithms.
- Incorporating anatomical data, specifically CAC and carotid plaque presence, significantly enhances CVD risk stratification and reduces underestimation.
Objective:
The study we assessed how often patients who are manifesting a myocardial infarction (MI) would not be considered candidates for intensive lipid-lowering therapy based on the current guidelines.
Methods:
In 355 consecutive patients manifesting ST elevation MI (STEMI), admission plasma C-reactive protein (CRP) was measured and Framingham risk score (FRS), PROCAM risk score, Reynolds risk score, ASSIGN risk score, QRISK, and SCORE algorithms were applied. Cardiac computed tomography and carotid ultrasound were performed to assess the coronary artery calcium score (CAC), carotid intima-media thickness (cIMT) and the presence of carotid plaques.
Results:
Less than 50% of STEMI patients would be identified as having high risk before the event by any of these algorithms. With the exception of FRS (9%), all other algorithms would assign low risk to about half of the enrolled patients. Plasma CRP was <1.0mg/L in 70% and >2mg/L in 14% of the patients. The average cIMT was 0.8±0.2mm and only in 24% of patients was ≥1.0mm. Carotid plaques were found in 74% of patients. CAC ≥100 was found in 66% of patients. Adding CAC ≥100 plus the presence of carotid plaque, a high-risk condition would be identified in 100% of the patients using any of the above mentioned algorithms.
Conclusion:
More than half of patients manifesting STEMI would not be considered as candidates for intensive preventive therapy by the current clinical algorithms. The addition of anatomical parameters such as CAC and the presence of carotid plaques can substantially reduce the CVD risk underestimation.
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