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.
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