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October 15, 2015Journal of Atherosclerosis and ThrombosisOpen Access

Lower mean carotid wall shear stress was a significant independent predictor of significant coronary artery disease in patients with chest pain (OR 0.554).

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Why the study?

Does low carotid artery wall shear stress predict the presence of significant coronary artery disease in patients with chest pain?

Population

950 consecutive eligible patients admitted to the hospital with suspected coronary artery disease undergoing…

Comparison

Carotid ultrasound measurement of hemodynamic… vs Patients without significant coronary artery…

Design

Cross-sectional, Two observers measuring carotid parameters were blinded to…

Key result

Lower mean carotid wall shear stress was a significant independent predictor of significant coronary artery disease in patients with chest pain (OR 0.554).

Authors

KCKyoung Im ChoBKBo Hyun KimHKHyun Su Kim

Discussion

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Member takes

Overview

Should not yet change chest pain evaluation; hypothesis-generating for carotid shear stress in CAD prediction.

Study Design

Type

Cross-Sectional (n=950)

Multicenter

No

Structured PICO

Does low carotid artery wall shear stress predict the presence of significant coronary artery disease in patients with chest pain?

P
Population
950 patients with chest pain and suspected coronary artery disease who underwent coronary angiography and carotid ultrasound.
E
Exposure
Carotid ultrasound measurement of hemodynamic parameters including peak and mean wall shear stress (WSS), mean intima-media thickness (IMT), and total plaque area (TPA).
C
Comparator
Patients without significant coronary artery disease (n=667) compared to patients with significant coronary artery disease (n=283).
O
Outcome
Presence of significant coronary artery disease (defined as at least one lesion >50% within the main branches of the coronary arteries on coronary angiography).surrogate

Main Result

Odds Ratio: 0.554 (95% CI 0.371–0.838)

Absolute Event Rate: 2.23% vs 2.59%

p-value: p=0.005

In patients presenting with chest pain, low carotid artery wall shear stress and high total plaque burden are significant independent predictors of underlying significant coronary artery disease.

Limitations

  • Unique study cohort from a single center, which may limit generalizability to other populations.
  • Technical limitations in plaque measurement for diffuse plaques connected by increased IMT.
  • WSS measurement was based only on Poiseuille's law, which assumes a parabolic velocity profile and may underestimate true WSS.
  • Genetic factors and other CHD risk factors (e.g., fibrinogen, alcohol use, physical activity, homocysteine) were not investigated.
  • Cross-sectional design means associations with future CAD events could not be investigated.

Cite This Study

Cho et al. (2015) conducted a cross-sectional in Suspected coronary artery disease (n=950). Carotid artery wall shear stress vs. Higher wall shear stress was evaluated on Presence of significant coronary artery disease (≥50% stenosis) (OR 0.554, 95% CI 0.371-0.838, p=0.005). Lower mean carotid wall shear stress was a significant independent predictor of significant coronary artery disease in patients with chest pain (OR 0.554).

synapsesocial.com/papers/6a96dd7a2d8f86faeeb2fa49https://doi.org/10.5551/jat.31377
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Association Between Wall Shear Stress and Carotid Atherosclerosis in Patients With Never Treated Essential Hypertension2009 · 32 citations
  2. 2Wall shear stress in hypertensive patients is associated with carotid vascular deformation assessed by speckle tracking strain imaging2014 · 37 citations
  3. 3Association Between Hemodynamics in the Common Carotid Artery and Severity of Carotid Atherosclerosis in Patients With Essential Hypertension2008 · 26 citations
  4. 4Wall Shear Stress Is Associated With Intima-Media Thickness and Carotid Atherosclerosis in Subjects at Low Coronary Heart Disease Risk2004 · 120 citations
  5. 5Localized Elevation of Wall Shear Stress Is Linked to Recent Symptoms in Patients with Carotid Stenosis2022 · 17 citations