Carotid Atherosclerosis in Predicting Coronary Artery Disease

Abstract

Objective: This meta-analysis aims to compare the relationship between phenotypic manifestation of coronary and carotid atherosclerosis using available imaging techniques. Approach and Results: We searched all electronic databases until October 2020 for studies which reported relationship between carotid and coronary atherosclerosis. The primary end point was correlation between carotid intima-media thickness (CIMT) and carotid plaque features (calcification and lipid-rich necrotic core) with coronary artery disease (CAD). Secondary end points included carotid pathology that predicts CAD. Eighty-nine papers with 22 683 patients comparing carotid and coronary atherosclerosis were included in the analysis. CIMT was increased linearly with severity of CAD irrespective of its significance ( P <0.001), mono versus 2 vessel disease ( P =0.003), and 2 versus multivessel disease ( P <0.001). Carotid plaque presence and calcification were less, and lipid-rich necrotic core was highly prevalent in nonsignificant versus significant CAD ( P <0.001, P =0.03, P <0.001, respectively). Moderate correlation was found between CIMT and severity of CAD ( r =0.60, P <0.001) and the number of diseased vessels ( r =0.49, P <0.001). There was a moderate correlation between carotid and coronary stenosis ( r =0.53, P <0.001) and between carotid and coronary calcification ( r =0.61, P <0.001). CIMT ≥1.0 mm with a summary sensitivity of 77% and summary specificity of 72% and respective values of 80% and 67% for carotid plaque were the best predictors of CAD, irrespective of the technique used for its diagnosis. Conclusions: These results support the concept that atherosclerosis affects both carotid and coronary systems, although not always in identical phenotypic manner. These findings highlight the beneficial examination of carotid arteries whenever CAD is suspected.

Regulatory T Cell-Related Gene Biomarkers in the Deterioration of Atherosclerosis

“…The carotid and coronary arteries are the two most common systems afflicted by atherosclerosis. Despite the different anatomical locations, the two artery systems have been suggested to share a similar phenotypic pattern of atherosclerosis in plaque formation, luminal narrowing or obstruction, and arterial wall calcification ( 50 ). Therefore, the hub genes derived from carotid atherosclerosis deterioration may be related to the acute clinical phenotype of coronary plaques such as MI.…”

Clinical Significance of Carotid Intima-Media Complex and Carotid Plaque Assessment by Ultrasound for the Prediction of Adverse Cardiovascular Events in Primary and Secondary Care Patients

“…A variety of studies evaluated the relationship between CIMT and presence of atherosclerotic abnormalities in the other territories of the arterial system [ 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ]. Most studies demonstrated associations between increasing CIMT value and presence and severity of a significant arterial disease (defined as at least 50% or more lumen reduction): CAD, renal artery stenosis, lower and upper extremity athero-oclussive disease, or the abdominal aorta [ 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ]. However, correlations between CIMT with incidence and severity of lesions in the other arterial sites are modest, especially when only CIMT-CCA is reported [ 78 , 79 , 80 ].…”

“…A recent meta-analysis of 89 studies showed moderate correlation between CIMT and severity of CAD (r = 0.60, p < 0.001) and the number of diseased vessels (r = 0.49, p < 0.001) [ 67 ]. Additionally, carotid plaque presence and calcification were less, and lipid-rich necrotic core was highly prevalent in nonsignificant versus significant CAD ( p < 0.001, p = 0.03, p < 0.001, respectively) [ 67 ]. In another large meta-analysis, including 22 studies, the diagnostic sensitivity and specificity of CIMT for CAD were 0.68 and 0.70, respectively [ 81 ].…”

Comprehensive analysis of dysregulated genes associated with atherosclerotic plaque destabilization

“…These two artery systems are believed to share similar atherosclerotic phenotypes in plaque formation, luminal narrowing, and arterial wall calcification. 35 Thus, the hub genes identified by analyzing carotid APs may be also linked to the acute manifestation of coronary plaque destabilization. To test this hypothesis, we calculated an APDscore based on the gene expressions of the eight hub genes using GSVA method.…”