Background: We have reported that carotid intima-media thickness (CIMT) can be used as a screening test to identify patients with significant (more than 50% stenosed luminal diameter) coronary artery disease (CAD). However, the patients without significant CAD consisted of those who were not performed coronary angiography. We sought to evaluate the role of CIMT as a screening test to identify the significant CAD out of those underwent coronary angiography.
Methods: The study subjects consisted of 1672 consecutive patients (60±11 years old, 913 males) who underwent coronary angiography and common CIMT measurement using high-resolution ultrasound and semi-automatic method.
Results: Patients with significant CAD (n=1069) were older (60.5±10.7 yrs vs. 58.0±11.0yrs, P<0.001), more likely to be male gender (60.9% vs. 43.4%, P<0.001), more likely to have hypertension (53.1% vs. 42.5%, P<0.001), diabetes (28.8% vs. 15.6%, P<0.001) and smoker (36.6% vs. 19.9%, P<0.001) than those without significant CAD (n=603). Patients with significant CAD had thicker CIMT (0.816±0.188mm vs. 0.780±0.166mm, P<0.001), higher prevalence of carotid plaque (36.8% vs. 22.0%, P<0.001), lower high-density lipoprotein cholesterol (42.2±10.8mg/dl vs. 43.6±10.7mg/dl, P=0.012), and higher blood urea nitrogen (16.8±7.5mg/dl vs. 15.7±5.3mg/dl, P=0.002), creatinine (1.06±0.8mg/dl vs. 0.94±0.6mg/dl, P=0.002), and uric acid (5.12±1.6mg/dl vs. 4.96±1.5mg/dl, P=0.049) level than those without significant CAD. ROC curve analysis revealed that CIMT value of 0.755mm had a low sensitivity (58.3%) and specificity (51.1%) for identification of significant CAD. Multivariate analysis revealed that the independent factors for significant CAD were age (Β=0.082, P=0.002), male gender (Β=0.141, P<0.001), hypertension (Β=0.074, P=0.004), diabetes (Β=0.142, P<0.001), smoking (Β=0.121, P<0.001), and the presence of carotid plaque (Β=0.121, P<0.001).
Conclusions: CIMT can not be used as a screening test for CAD and may be used as a prognostic factor which needs to be studied. Carotid plaque can be served as a marker for significant CAD, although the prevalence of it is low in Korean.
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