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Background: Global cardiovascular risk scores underestimate risk in persons with asymptomatic cardiac lesions who go on to experience cardiovascular events. The Get With The Guidelines analysis revealed that 83% of patients with first cardiac events were at guideline targets for LDL. IVUS (intravascular ultrasound) shows that most flow-disrupting acute coronary syndromes (ACS) occur in asymptomatic less than 50% stenotic lesions. Identifying vulnerable patients with these lesions at risk of ACS events using multi-biomarker algorithms quantifying immune response to endothelial damage is of great interest.
Methods: We studied 725 adults (> or = 18 yrs) from Cardiology practices who received a 5-year modified Framingham Risk Score (mFRS), and an ACS predictive algorithm (ACSPA) multi-biomarker score. ACSPA incorporates 9 biomarkers (CTACK, Eotaxin, Fas Ligand, HGF, IL-16, MCP-3, sFas, HDL, and HbA1c) with age, sex, diabetes, and positive family history previously shown to more accurately reclassify risk of ACS (cNRI=43%). Patients were classified into low (< 3.5%), intermediate (3.5% – < 7.5%), and high (> or = 7.5%) 5-year risk categories with both mFRS and ACSPA. Patients at low or intermediate risk by mFRS, but reclassified high by ACSPA are reported and compared.
Results: Persons at low, intermediate, and high global risk categories were successively more likely to show high-risk scores with ACSPA (Figure). However, 349 (65%) in the low mFRS risk group were reclassified into higher ACSPA risk groups and 104 (70%) intermediate risk patients were reclassified into the high-risk group (p<0.0001 for ACSPA vs mFRS). Analysis showed that 89% (309) of the low or intermediate mFRS [125 females (99%); 184 males (83%); p<0.0001] and, 86 below 65 years (93%) and 223 above 65 years (88%); p=0.26)] were classified as high-risk by ACSPA, indicating that many persons who may be at high risk are not identified as such by global risk assessment.
Conclusions: This novel ACSPA identifies many persons at increased risk of cardiac events due to asymptomatic cardiac lesions missed by traditional global risk methods. Further investigation of ACSPA for prediction of near-term CVD events is required.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Considerations in Antiplatelet Therapy and in ACS
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1113-144
- 2017 American College of Cardiology Foundation