The use of carotid ultrasound to predict the severity of coronary artery disease

Background and Aims: Increased carotid intima-media thickness (cIMT) has been extensively evaluated as a marker of cardiovascular risk. However, there are only limited data correlating cIMT/other carotid measurements with presence/severity of coronary artery disease (CAD). Methods: Patients with ischemic-type chest pain undergoing Invasive Coronary Angiography (ICA) or Computed Tomography Coronary Angiography (CTCA) underwent high-resolution B-mode ultrasound to measure cIMT and 3D-imaging to measure total plaque volume and maximum area reduction. Age/sex-adjusted cIMT normal ranges were defined based on previous independent population studies. (Study grant:EU-INTERREG). Results: We studied 258 subjects (70.2% male, mean age 64.98±12years). Cardiovascular risk factors included family history(72%), current/exsmoker(56%), hypertension(65%), hyperlipidemia(70%) or diabetes(21%). On ICA or CTCA, severe CAD (70% area stenosis or positive pressure-wire study) was present in 1 vessel in 167(65%) of patients. Severe multivessel disease was present in 101(39%) patients. cIMT50th vs cIMT<50th percentile predicted increased risk of any CAD in 1 coronary arteries (82.2% vs 26.7%;RR 3.08[95%CI 1.89e5.02];p<0.0001), increased risk of severe disease in 1 vessels (88% vs 44%; RR 2.0[95%CI 1.58e2.54];p<0.0001) and increased risk of severe multivessel disease (89.1% vs 61.8%; RR 1.44[95%CI 1.25e1.66];p<0.0001). While cIMT75th percentile was also associated with increased risk, it did not improve the predictive value compared with cIMT50th percentile. 3D imaging of total plaque volume and maximum area reduction did not improve prediction. Conclusions: cIMT50th percentile predicted increased risk of CAD in 1 vessel and thus may be a useful tool to identify patients with chest discomfort most likely to benefit from further invasive investigation.