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Impact of Framingham risk score, flow-mediated dilation, pulse wave velocity, and biomarkers for cardiovascular events in stable angina.

Park KH, Han SJ, Kim HS, Kim MK, Jo SH, Kim SA, Park WJ - J. Korean Med. Sci. (2014)

Bottom Line: After CAG, 134 patients showed significant coronary artery disease.However, there was no difference in predictive power between combining AFRS plus FMD and AFRS alone (AUC 0.752 vs. 0.763; z=1.358, P=0.175).However, there is no additive value of FMD on the AFRS in predicting CVEs.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea.

ABSTRACT
Although the age-adjusted Framingham risk score (AFRS), flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV), high-sensitivity C-reactive protein (hsCRP), fibrinogen, homocysteine, and free fatty acid (FFA) can predict future cardiovascular events (CVEs), a comparison of these risk assessments for patients with stable angina has not been reported. We enrolled 203 patients with stable angina who had been scheduled for coronary angiography (CAG). After CAG, 134 patients showed significant coronary artery disease. During 4.2 yr follow-up, 36 patients (18%) showed CVEs, including myocardial infarction, de-novo coronary artery revascularization, in-stent restenosis, stroke, and cardiovascular death. ROC analysis showed that AFRS, FMD, baPWV, and hsCRP could predict CVEs (with AUC values of 0.752, 0.707, 0.659, and 0.702, respectively, all P<0.001 except baPWV P=0.003). A Cox proportional hazard analysis showed that AFRS and FMD were independent predictors of CVEs (HR, 2.945; 95% CI, 1.572-5.522; P=0.001 and HR, 0.914; 95% CI, 0.826-0.989; P=0.008, respectively). However, there was no difference in predictive power between combining AFRS plus FMD and AFRS alone (AUC 0.752 vs. 0.763; z=1.358, P=0.175). In patients with stable angina, AFRS and FMD are independent predictors of CVEs. However, there is no additive value of FMD on the AFRS in predicting CVEs.

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Related in: MedlinePlus

Receiver operating characteristic curves of the AFRS and the AFRS plus FMD for the prediction of cardiovascular events. AFRS, age-adjusted Framingham risk score; FMD, flow-mediated dilation.
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Figure 1: Receiver operating characteristic curves of the AFRS and the AFRS plus FMD for the prediction of cardiovascular events. AFRS, age-adjusted Framingham risk score; FMD, flow-mediated dilation.

Mentions: The results of the ROC analysis for CVEs with the AFRS, FMD, baPWV, hsCRP, fibrinogen, homocysteine, and FFA are shown in Table 2. The predictive power of the AFRS was shown to be best and was significantly better than the fibrinogen (z=2.463, P=0.014), homocysteine (z=2.206, P=0.027), and FFA (z=2.288, P=0.022). However, the predictive power of the AFRS was not statistically different from the FMD (z=0.759, P=0.448), baPWV (z=1.794, P=0.073), and hsCRP (z=0.865, P=0.387). Including aspirin and statin, the Cox proportional hazard analysis was performed with the AFRS, FMD, baPWV, and hsCRP which significantly predicted CVEs on the ROC analysis. The AFRS and FMD were independent predictors for CVEs (HR, 2.945; 95% CI, 1.572-5.522, P=0.001 and HR, 0.914; 95% CI, 0.826-0.989, P=0.008, respectively; Table 3). The area under the ROC curves of combined parameters of AFRS plus FMD indicating a future CVE was 0.763 (95% CI, 0.698-0.820; P<0.001). However, there was no difference in the power between combining the AFRS plus FMD and AFRS alone for predicting a CVE (z=1.358, P=0.175; Fig. 1). In the 134 patients with sCAD, we also evaluated for a coronary event, which removed stroke from CVEs. In patients with sCAD, the clinical results may be affected by the lesion characteristics and number of diseased vessels on CAG or by treatment strategy (medical treatment or PCI) (18). According to the ACC/AHA coronary artery lesion classification, 12 patients had type A, 37 patients had type B1, 37 patients had type B2, and 48 patients had type C lesions (19). In terms of the number of diseased vessels, 79 patients had one vessel disease, 33 patients had two and 22 patients had three. During the study period, 19 patients underwent PCI due to progression of CAD, and eight patients showed in-stent restenosis; in total, 27 coronary events occurred. In the 134 patients with sCAD, the ROC analysis for coronary events with the AFRS, FMD, baPWV, hsCRP, fibrinogen, homocysteine, and FFA are shown in Table 4. The predictive power of the AFRS was significantly better than the fibrinogen (z=2.006, P=0.045) and homocysteine (z=2.353, P=0.019). However, the predictive power of the AFRS was not statistically different from the FMD (z=0.505, P=0.613), baPWV (z=1.541, P=0.123), hsCRP (z=1.026, P=0.305), and FFA (z=1.577, P=0.115). In addition to the class of the coronary artery lesion, number of coronary artery disease, and PCI, the Cox proportional hazard analysis was performed with the AFRS, FMD, baPWV, and hsCRP, which significantly predicted coronary events on the ROC analysis. The AFRS was an independent predictor for coronary events and the FMD showed marginal significance (Table 5). The area under the ROC curves of combined parameters of AFRS plus FMD indicating coronary events was 0.736 (95% CI, 0.653-0.808; P<0.001). However, there was no difference in the power between combining the AFRS plus FMD and the AFRS alone for predicting coronary events (0.736 vs. 0.731; z=0.474, P=0.635).


Impact of Framingham risk score, flow-mediated dilation, pulse wave velocity, and biomarkers for cardiovascular events in stable angina.

Park KH, Han SJ, Kim HS, Kim MK, Jo SH, Kim SA, Park WJ - J. Korean Med. Sci. (2014)

Receiver operating characteristic curves of the AFRS and the AFRS plus FMD for the prediction of cardiovascular events. AFRS, age-adjusted Framingham risk score; FMD, flow-mediated dilation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214940&req=5

Figure 1: Receiver operating characteristic curves of the AFRS and the AFRS plus FMD for the prediction of cardiovascular events. AFRS, age-adjusted Framingham risk score; FMD, flow-mediated dilation.
Mentions: The results of the ROC analysis for CVEs with the AFRS, FMD, baPWV, hsCRP, fibrinogen, homocysteine, and FFA are shown in Table 2. The predictive power of the AFRS was shown to be best and was significantly better than the fibrinogen (z=2.463, P=0.014), homocysteine (z=2.206, P=0.027), and FFA (z=2.288, P=0.022). However, the predictive power of the AFRS was not statistically different from the FMD (z=0.759, P=0.448), baPWV (z=1.794, P=0.073), and hsCRP (z=0.865, P=0.387). Including aspirin and statin, the Cox proportional hazard analysis was performed with the AFRS, FMD, baPWV, and hsCRP which significantly predicted CVEs on the ROC analysis. The AFRS and FMD were independent predictors for CVEs (HR, 2.945; 95% CI, 1.572-5.522, P=0.001 and HR, 0.914; 95% CI, 0.826-0.989, P=0.008, respectively; Table 3). The area under the ROC curves of combined parameters of AFRS plus FMD indicating a future CVE was 0.763 (95% CI, 0.698-0.820; P<0.001). However, there was no difference in the power between combining the AFRS plus FMD and AFRS alone for predicting a CVE (z=1.358, P=0.175; Fig. 1). In the 134 patients with sCAD, we also evaluated for a coronary event, which removed stroke from CVEs. In patients with sCAD, the clinical results may be affected by the lesion characteristics and number of diseased vessels on CAG or by treatment strategy (medical treatment or PCI) (18). According to the ACC/AHA coronary artery lesion classification, 12 patients had type A, 37 patients had type B1, 37 patients had type B2, and 48 patients had type C lesions (19). In terms of the number of diseased vessels, 79 patients had one vessel disease, 33 patients had two and 22 patients had three. During the study period, 19 patients underwent PCI due to progression of CAD, and eight patients showed in-stent restenosis; in total, 27 coronary events occurred. In the 134 patients with sCAD, the ROC analysis for coronary events with the AFRS, FMD, baPWV, hsCRP, fibrinogen, homocysteine, and FFA are shown in Table 4. The predictive power of the AFRS was significantly better than the fibrinogen (z=2.006, P=0.045) and homocysteine (z=2.353, P=0.019). However, the predictive power of the AFRS was not statistically different from the FMD (z=0.505, P=0.613), baPWV (z=1.541, P=0.123), hsCRP (z=1.026, P=0.305), and FFA (z=1.577, P=0.115). In addition to the class of the coronary artery lesion, number of coronary artery disease, and PCI, the Cox proportional hazard analysis was performed with the AFRS, FMD, baPWV, and hsCRP, which significantly predicted coronary events on the ROC analysis. The AFRS was an independent predictor for coronary events and the FMD showed marginal significance (Table 5). The area under the ROC curves of combined parameters of AFRS plus FMD indicating coronary events was 0.736 (95% CI, 0.653-0.808; P<0.001). However, there was no difference in the power between combining the AFRS plus FMD and the AFRS alone for predicting coronary events (0.736 vs. 0.731; z=0.474, P=0.635).

Bottom Line: After CAG, 134 patients showed significant coronary artery disease.However, there was no difference in predictive power between combining AFRS plus FMD and AFRS alone (AUC 0.752 vs. 0.763; z=1.358, P=0.175).However, there is no additive value of FMD on the AFRS in predicting CVEs.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea.

ABSTRACT
Although the age-adjusted Framingham risk score (AFRS), flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV), high-sensitivity C-reactive protein (hsCRP), fibrinogen, homocysteine, and free fatty acid (FFA) can predict future cardiovascular events (CVEs), a comparison of these risk assessments for patients with stable angina has not been reported. We enrolled 203 patients with stable angina who had been scheduled for coronary angiography (CAG). After CAG, 134 patients showed significant coronary artery disease. During 4.2 yr follow-up, 36 patients (18%) showed CVEs, including myocardial infarction, de-novo coronary artery revascularization, in-stent restenosis, stroke, and cardiovascular death. ROC analysis showed that AFRS, FMD, baPWV, and hsCRP could predict CVEs (with AUC values of 0.752, 0.707, 0.659, and 0.702, respectively, all P<0.001 except baPWV P=0.003). A Cox proportional hazard analysis showed that AFRS and FMD were independent predictors of CVEs (HR, 2.945; 95% CI, 1.572-5.522; P=0.001 and HR, 0.914; 95% CI, 0.826-0.989; P=0.008, respectively). However, there was no difference in predictive power between combining AFRS plus FMD and AFRS alone (AUC 0.752 vs. 0.763; z=1.358, P=0.175). In patients with stable angina, AFRS and FMD are independent predictors of CVEs. However, there is no additive value of FMD on the AFRS in predicting CVEs.

Show MeSH
Related in: MedlinePlus