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Background Intravascular ultrasound(IVUS) is increasingly used as an end poin t in studies aimed at reducing progression or inducing regression of coronary ar tery disease. However, data linking serial changes by IVUS with clinical outcome s are scarce. Methods and Results In the absence of a validated risk score for secondary prevention, we compared 3 established risk scores for primary preventi on PROCAM, SCORE, and Framingham with plaque progression and lumen reduction a s assessed with serial IVUS(follow up, 18±9 months) in atherosclerotic left ma in coronary arteries of 56 patients with established atherosclerosis. For all 3 algorithms, patients at highest estimated risk of events showed greater plaque p rogression 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 i n lumen dimensions with increasing risk(P< 0.05, PROCAM and SCORE). Risk predict ion using the PROCAM algorithm showed the strongest relation with serial IVUS. D uring follow up, 18 patients suffered from adverse cardiovascular events; these patients had an annual plaque progression that was significantly greater than o ther 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 deri ved from all 3 established risk score algorithms and the extent of plaque progr ession measured by serial IVUS. This translated into stenosis progression (reduc tion in lumen dimensions) with increasing clinical risk.
Background Intravascular ultrasound (IVUS) is increasingly used as an end poin t in studies aimed at reducing progression or inducing regression of coronary ar disease. However, data linking serial changes by IVUS with clinical outcome s are scarce. Methods and Results In the absence of of a validated risk score for secondary prevention, we compared 3 established risk scores for primary preventi on PROCAM, SCORE, and Framingham with plaque progression and lumen reduction as assessed with serial IVUS (follow up, 18 ± 9 months) in atherosclerotic left ma in coronary ateries of 56 patients with established atherosclerosis. For all 3 algorithms, patients at highest estimated risk of events was greater plaque p rogression than patients at bottom 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 predict ion using the PROCAM algorithm showed the strongest relation with serial IVUS. D uring follow up, 18 patients suffered from adverse cardiovascular events; these patients had an annual plaque progression that was significantly greater than o ther 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 progr ession measured by serial IVUS. This translated into stenosis progression (reduc tion in lumen dimensions) with increasing clinical risk.