Key result
Carotid ultrasound screening by primary care physicians in asymptomatic patients with multiple risk factors identified a high prevalence of coronary artery disease, with an LDL/HDL ratio significantly predicting >50% coronary stenosis (OR 3.46).
Why the study?
Does carotid ultrasound screening by primary care physicians identify significant coronary artery disease in asymptomatic patients with multiple risk factors?
Observational (n=135)
No
Does carotid ultrasound screening by primary care physicians identify significant coronary artery disease in asymptomatic patients with multiple risk factors?
Odds Ratio: 3.46 (95% CI 1.59–7.55)
p-value: p=<0.01
Carotid ultrasound screening by primary care physicians in asymptomatic high-risk patients effectively identifies those with significant coronary artery disease requiring further evaluation and revascularization.
Supports carotid ultrasound screening in high-risk asymptomatic patients; leaves open whether routine use improves outcomes.
BACKGROUND: In this study, we investigated the feasibility of primary care physicians using carotid ultrasound to perform coronary artery disease screening in asymptomatic patients with multiple coronary risk factors. METHODS: We retrospectively collected the data of 135 consecutive asymptomatic patients (mean age: 68.5 ± 8.4 years; male, 75%) who were referred to our institution due to abnormal findings on a carotid ultrasound performed by a primary care physician and who underwent coronary computed tomography angiography. RESULTS: The mean number of risk factors was 4.1 ± 1.2 and the mean intima-media thickness was 2.00 ± 0.63 mm. Mild (≤ 50%), moderate (51-75%), and severe (> 76%) coronary stenosis was observed in 54 (40%), 27 (20%), and 25 patients (19%), respectively, while no plaque was found in 24 patients (18%), and five patients (4%) could not be evaluated due to calcification. Consequently, coronary angiography was performed in 56 (41%) patients and coronary intervention was required in 31 patients (23%). A multivariate logistic regression analysis demonstrated that the ratio of low-density lipoprotein cholesterol levels to high-density lipoprotein cholesterol levels, the use of calcium channel blockers and the value of the diastolic blood pressure were related to > 50% coronary stenosis. CONCLUSIONS: The use of carotid ultrasound in the coronary artery disease screening by primary care physicians resulted in a high prevalence of coronary artery disease and high probabilities of coronary angiography and revascularization, and thus it is considered to be a useful and feasible strategy for the screening of asymptomatic patients.
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Okahara et al. (2016) conducted an observational in Asymptomatic patients with multiple coronary risk factors (n=135). Carotid ultrasound screening was evaluated on > 50% coronary stenosis (predicted by LDL/HDL ratio) (OR 3.46, 95% CI 1.59-7.55, p=<0.01). Carotid ultrasound screening by primary care physicians in asymptomatic patients with multiple risk factors identified a high prevalence of coronary artery disease, with an LDL/HDL ratio significantly predicting >50% coronary stenosis (OR 3.46).
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