Development and internal validation of a 5-year major cardiovascular and cerebrovascular events prediction model using a simplified carotid plaque score in a hospital-based primary-prevention cohort
- 1Department of Ultrasound, Cardiovascular and Cerebrovascular Disease Hospital, General Hospital of Ningxia Medical University
Abstract
Background: Carotid plaque burden is an established cardiovascular risk marker, but the incremental predictive value of a simplified six-segment plaque score within a multivariable model remains less well characterized in hospital-based Chinese primary-prevention populations. We aimed to develop and internally validate a 5-year model for major adverse cardiovascular and cerebrovascular events (MACE) incorporating this score.
Methods: This single-center retrospective cohort included adults aged ≥40 years without prior clinical cardiovascular or cerebrovascular disease who underwent bilateral carotid ultrasonography between 2015 and 2020. Plaque presence in six carotid segments generated a 0–6 score. The primary outcome was 5-year hard MACE, defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal ischemic stroke. Three Cox models were compared: clinical predictors alone, clinical predictors plus binary plaque presence, and clinical predictors plus plaque score. Performance was assessed by discrimination, calibration, Brier score, decision curve analysis, and 1,000 bootstrap resamples.
Results: Among 2,413 patients, 1,560 (64.6%) had carotid plaque and 108 experienced hard MACE during a median follow-up of 4.92 years. Five-year MACE incidence increased from 1.5% for plaque scores 0–1 to 6.1% for scores 2–4 and 15.4% for scores 5–6 ( P < 0.001). Each 1-point score increase was associated with higher MACE risk (HR, 1.32; 95% CI, 1.21–1.44). The apparent C-index increased from 0.753 for the clinical model to 0.804 with the plaque score; the corresponding 5-year AUC and Brier score were 0.807 and 0.0381. After bootstrap correction, the C-index was 0.792 and calibration slope 0.93. Model 3 showed greater net benefit across most 2%–10% thresholds, with broadly similar findings in sensitivity analyses.
Conclusions: In this hospital-based primary-prevention cohort, the simplified six-segment carotid plaque score provided incremental predictive information beyond conventional clinical factors and binary plaque presence. External validation, particularly in lower-risk community and primary-care populations, is required before broader clinical application.
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BibTeX
@article{hu2026development,
title = {{Development and internal validation of a 5-year major cardiovascular and cerebrovascular events prediction model using a simplified carotid plaque score in a hospital-based primary-prevention cohort}},
author = {Haitao Hu and Daoyan Li and Qian Zhang},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1966647},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1966647/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Development and internal validation of a 5-year major cardiovascular and cerebrovascular events prediction model using a simplified carotid plaque score in a hospital-based primary-prevention cohort
AU - Haitao Hu
AU - Daoyan Li
AU - Qian Zhang
PY - 2026
DA - 2026/10/28
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1966647
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1966647/full
AB - Background: Carotid plaque burden is an established cardiovascular risk marker, but the incremental predictive value of a simplified six-segment plaque score within a multivariable model remains less well characterized in hospital-based Chinese primary-prevention populations. We aimed to develop and internally validate a 5-year model for major adverse cardiovascular and cerebrovascular events (MACE) incorporating this score. Methods: This single-center retrospective cohort included adults aged ≥40 years without prior clinical cardiovascular or cerebrovascular disease who underwent bilateral carotid ultrasonography between 2015 and 2020. Plaque presence in six carotid segments generated a 0–6 score. The primary outcome was 5-year hard MACE, defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal ischemic stroke. Three Cox models were compared: clinical predictors alone, clinical predictors plus binary plaque presence, and clinical predictors plus plaque score. Performance was assessed by discrimination, calibration, Brier score, decision curve analysis, and 1,000 bootstrap resamples. Results: Among 2,413 patients, 1,560 (64.6%) had carotid plaque and 108 experienced hard MACE during a median follow-up of 4.92 years. Five-year MACE incidence increased from 1.5% for plaque scores 0–1 to 6.1% for scores 2–4 and 15.4% for scores 5–6 ( P < 0.001). Each 1-point score increase was associated with higher MACE risk (HR, 1.32; 95% CI, 1.21–1.44). The apparent C-index increased from 0.753 for the clinical model to 0.804 with the plaque score; the corresponding 5-year AUC and Brier score were 0.807 and 0.0381. After bootstrap correction, the C-index was 0.792 and calibration slope 0.93. Model 3 showed greater net benefit across most 2%–10% thresholds, with broadly similar findings in sensitivity analyses. Conclusions: In this hospital-based primary-prevention cohort, the simplified six-segment carotid plaque score provided incremental predictive information beyond conventional clinical factors and binary plaque presence. External validation, particularly in lower-risk community and primary-care populations, is required before broader clinical application.
SN - 2297-055X
ER -