Risk factors and utility of maximum carotid intima–media thickness as a surrogate marker for coronary artery stenosis

Abstract

Keiji Hirai,1 Shigeki Imamura,2 Aizan Hirai,2 Kazuo Misumi,3 Susumu Ookawara,1 Yoshiyuki Morishita1 1Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan; 2Department of Internal Medicine, Chiba Cerebral and Cardiovascular Center, Chiba, Japan; 3Division of Cardiology, Heart Institute, Chiba-Nishi General Hospital, Chiba, Japan Background: This study investigated the factors associated with coronary artery stenosis in outpatients. Furthermore, the usefulness of maximum carotid intima–media thickness (maximum-IMT) as a surrogate marker of coronary artery stenosis was evaluated. Methods: We conducted a single-center retrospective study. A total of 601 outpatients (338 males; 263 females; mean age, 69.8±10.0 years) who underwent coronary computed tomography angiography between April 2006 and March 2012 were analyzed. The associations between coronary artery stenosis (≥75%) as determined by coronary computed tomography angiography and clinical and laboratory parameters were evaluated by multivariate logistic regression. Validation of maximum-IMT as measured by ultrasonography as a surrogate marker of coronary artery stenosis was analyzed by receiver operating characteristic (ROC) curve analysis. Results: The estimated glomerular filtration rate (eGFR: mL/min/1.73 m2) (odds ratio [OR] 0.985, p<0.01), diabetes mellitus (OR 1.98, p<0.05), and maximum-IMT (mm) (OR 1.76, p<0.01) were significantly associated with coronary artery stenosis (≥75%). In analysis of each group categorized by identified factors, such as renal impairment (eGFR <60 mL/min/1.73 m2) and diabetes mellitus, the ROC curve of maximum-IMT was significant in the group of patients with diabetes mellitus without renal impairment (p<0.01) (cutoff value of maximum-IMT, 2.0 mm; sensitivity, 0.74; and specificity, 0.54) but not in other groups. Conclusion: Renal impairment, diabetes mellitus, and increased maximum-IMT may be significant risk factors of coronary artery stenosis. Maximum-IMT as measured by ultrasonography may be a useful surrogate marker for coronary artery stenosis in patients with diabetes mellitus without renal impairment but not in other patients. Keywords: coronary artery stenosis, diabetes mellitus, maximum intima–media thickness, renal impairment

Keywords

• coronary artery stenosis
• diabetes mellitus
• maximum intima–media thickness
• renal impairment