Carotid intima-media thickness was significantly higher in patients with coronary slow flow compared to normal controls (pooled MD -0.14 mm; p<0.0001).
Is coronary slow flow associated with increased carotid intima-media thickness compared to normal coronary flow?
Coronary slow flow is associated with increased carotid intima-media thickness, supporting its role as a marker of systemic subclinical atherosclerosis.
Absolute Event Rate: 0% vs 0%
Carotid intima-media thickness (CIMT), a marker of systemic atherosclerosis, has been proposed as a prognostic marker of coronary slow flow (SCF). This systematic review and meta-analysis was performed to evaluate the predictive outcomes of CIMT in SCF patients compared to patients with normal coronary flow (NCF). This systematic review, conducted according to PRISMA and a pre-specified PECOS protocol, systematically searched PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar for observational studies (cohort, case-control, cross-sectional) comparing CIMT and TIMI frame count (TFC) in SCF versus NCF patients. Two reviewers independently extracted data and assessed methodological quality using ROBINS-I and AXIS. A random-effects model estimated mean differences (MD) in CIMT and TFC, with heterogeneity evaluated by the I 2 statistic. Eight studies involving 451 SCF patients and 344 NCF controls were included. CIMT was significantly higher in SCF patients (pooled MD −0.14 mm; 95% CI −0.21 to −0.07; I 2 =91%; p<0.0001). Seven studies showed higher CIMT in SCF patients (MD −0.40 to −0.11 mm; p<0.05), while one study found no difference (MD 0.01 mm; p=0.73). Maximal CIMT was consistently greater in SCF patients (MD −0.17 to −0.15 mm; p<0.01). In all studies, TFC demonstrated markedly reduced coronary flow in SCF patients (pooled MD −16.58 frames; 95% CI −18.08 to −15.08; I 2 =80%; p<0.00001). Qualitative synthesis correlated increased CIMT with endothelial dysfunction, systemic inflammation, reduced coronary and systemic vascular flow velocities, and early atherosclerotic changes, underscoring its prognostic significance. The association of slow coronary flow with increased carotid intima–media thickness supports its role as a marker of systemic subclinical atherosclerosis and highlights CIMT as a potential non-invasive tool for early risk stratification. • SCF and systemic vascular disease: SCF, once considered benign, is increasingly recognized as a marker of systemic endothelial dysfunction, microvascular impairment, and subclinical atherosclerosis. • CIMT as a prognostic marker: Meta-analysis of 8 studies demonstrated consistently higher CIMT in SCF patients compared to controls, supporting CIMT as a reliable non-invasive marker for early vascular disease and coronary microvascular dysfunction. • Clinical implications: Routine CIMT assessment in SCF patients may improve early detection and risk stratification of systemic atherosclerosis, though heterogeneity across studies highlights the need for standardized protocols and prospective validation.
Sharma et al. (Sun,) reported a other. Carotid intima-media thickness was significantly higher in patients with coronary slow flow compared to normal controls (pooled MD -0.14 mm; p<0.0001).