Clinical utility of readily available novel markers of carotid atherosclerotic burden for reclassification and discrimination of very high cardiovascular risk

Abstract Background Among high cardiovascular (CV) risk patients, there is emerging need to recognize those who will benefit from new treatments targeting residual risk. Readily available modalities providing reclassification value would be clinically useful in this setting. Preliminary data suggest that carotid ultrasonography using plaque burden but not intima-media thickness (IMT) associated with very Objectives We aimed assess the ability of two markers atherosclerosis high-risk reflecting total atherosclerotic and most severe lesion compare them routinely used indices IMT number plaques. Methods In an ongoing registry patients visited a protection clinic for assessment, we enrolled 735 consecutively recruited (mean age 63.1 years, 68.8% male) classified as or very-high CV according 2019 European Society Cardiology /European Atherosclerosis Guidelines. Sum wall (sumWT) maximal (maxWT) high-resolution at baseline were lesion, respectively. These integrate maximum height if no present. All followed median 41 months primary end-point consisted mortality, acute myocardial infarction coronary revascularization. Results After adjustment traditional factors, maxWT sumWT (hazard ratio [HR]=1.73 (95% confidence interval [CI]:1.39 2.17) 1.19 CI 1.10 1.30) respectively). Both superior terms discrimination identify over validated scores including Heartscore SMART score (net index [NRI]=0.624, p<0.0001, integrated [IDI]=0.060, p<0.0001 difference area under curve (δAUC) = 0.136, p<0.001 NRI=0.497, IDI=0.046, δAUC 0.128, sumWT), (NRI=0.502, IDI= 0.058, p=0.02 NRI=0.559, IDI=0.051, p=0.016 sumWT) plaques (NRI=0.614, IDI=0.038, p=0.001 NRI=0.292, p=0.019, IDI=0.022, p=0.009 sumWT). Conclusions The use novel cumulative improves stratification discriminates Given readily modality, its clinical application refinement facilitate treatment decisions merits further investigation. FUNDunding Acknowledgement Type funding sources: None.