Carotid intima-media thickness as a predictor of significant coronary artery disease in patients with NSTE-ACS

Abstract

The carotid intima-media thickness have been used as surrogate end-points for evaluating the regression and/or progression of atherosclerotic cardiovascular disease, but their predictive value in acute coronary artery disease is inconclusive. The aim of this study was to evaluate the ability of the carotid intima-media thickness to predict significant coronary artery disease in patients with NSTE-ACS. Patients admitted for NSTE-ACS and indication for coronary angiography were prospectively evaluated. Severe coronary artery disease was defined as the presence of stenosis > 70% of at least one major epicardial coronary artery or any of their major branches. A ROC curve was developed to define the carotid intima-media thickness cut-off that best predicts significant coronary artery disease. A total of 296 patients were evaluated: mean age was 62 ± 12 years and 58% were male. Two hundred and eighteen (73.6%) patients had significant coronary disease. Carotid intima-media thickness measurement in these patients was significantly higher than in those without significant coronary artery disease (0.87 ± 0.14 mm vs. 0.75 ± 0.13 mm; P < 10–3). Carotid intima-media thickness > 0.82 mm showed a sensitivity of 58.7%, specificity of 76.6%. The area under the ROC curve was 0.73 (95% confidence interval of 0.67–0.79). Carotid intima-media thickness > 0.82 mm had a good specificity to predict significant coronary disease in patients with NSTE-ACS. Considering its low cost and ease of use, its measurement may be incorporated to help in the assessment and stratification of NSTE-ACS patients for certain categories.