Association of carotid atherosclerosis with coronary artery disease: comparison between carotid ultrasonography and coronary angiography in patients with chest pain

Abstract

Several studies have shown that the risk of cardiovascular events is higher in subjects with ultrasound evidence of subclinical carotid atherosclerosis. The aim of our study was to demonstrate the correlation between carotid atherosclerosis and severity of coronary artery disease in patients with typical chest pain who performed Doppler ultrasound of carotid arteries and diagnostic coronary angiography during hospitalization. We studied 210 patients admitted to our cardiology unit for chest pain. Inclusion criteria were the presence of typical chest pain on admission to the emergency room and the performance of diagnostic coronary angiography and Doppler ultrasound examination of carotid arteries during hospitalization. Patients with positive biomarkers of myocardial infarction on admission to the emergency room and patients with a positive medical history for cardio- and cerebrovascular disease were excluded. Carotid ultrasound examination showed a 10% prevalence of normal carotid arteries, a 37% prevalence of intima-media carotid thickness and a 53% of asymptomatic carotid plaques. Coronary angiography showed that 29% of patients had normal coronary arteries, 26% had a coronary disease localized in a single vessel, 18% in two vessels, whereas 27% showed the involvement of three vessels. The presence of a normal carotid intima-media thickness was predominantly associated with the presence of angiographically normal coronary arteries (p=0.006), whereas the detection of asymptomatic carotid plaques at ultrasound examination was significantly correlated with three-vessel coronary artery disease (p=0.01). At logistic regression analysis, carotid atherosclerosis was predictive of severe coronary artery disease (odds ratio 2.1, 95% confidence interval 1.1-4.2, p=0.01). Given the significant correlation between the presence of preclinical carotid atherosclerosis and severity of coronary artery disease, the evaluation of carotid intima-media thickness might provide additional information for a more accurate determination of cardiovascular risk.