The Clinical Value of Intima-media Thickness in Patients with Stable Coronary Artery Disease and C-reactive Protein within Normal Limits

Q: What are the key findings of this study?

Higher carotid intima-media thickness (>0.76 mm) was independently associated with 3-vessel CAD (OR 1.714, 95% CI 1.050-2.799, p=0.003) and 2-vessel CAD (OR 1.711, p=0.010) in stable angina.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Stable coronary artery disease with normal hs-CRP (n=567). Intervention: Higher left carotid intima-media thickness (>0.76 mm median) vs. Lower left carotid intima-media thickness (<=0.76 mm median). Primary outcome: 3-vessel coronary artery disease (vs 1-vessel disease) (OR 1.714, 95% CI 1.050-2.799, p=0.003).

Q: What does this research mean for the field?

Higher carotid intima-media thickness is independently associated with multivessel coronary artery disease in stable angina patients with normal C-reactive protein levels. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jong Bum Kwon; Kuhn Park; Si Young Choi; Chan Beom Park; Yong Hwan Kim; Sung‐Ho Her; Mahn‐Won Park; Jong Ho Lee

doi:10.5090/kjtcs.2010.43.5.482

October 5, 2010The Korean Journal of Thoracic and Cardiovascular SurgeryOpen Access

The Clinical Value of Intima-media Thickness in Patients with Stable Coronary Artery Disease and C-reactive Protein within Normal Limits

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Key result

Higher carotid intima-media thickness linked to ~71% higher odds of 3-vessel CAD.

OR 1.714
95% CI 1.050-2.799
P=0.003
n=567

Why the study?

Whether hand-measured carotid intima-media thickness is a reliable and simple tool to evaluate the severity of stable CAD in patients with normal high-sensitivity C-reactive protein needed to be determined.

Is increased left carotid intima-media thickness associated with the angiographic severity of coronary artery disease in patients with stable angina and normal hs-CRP levels?

Key Points

To determine whether hand-measured carotid intima-media thickness can reliably evaluate the severity of stable coronary artery disease in patients with normal high-sensitivity C-reactive protein levels.
Evaluated 567 patients with stable coronary artery disease (stenosis >50% on coronary angiography) and normal hs-CRP (<0.5 mg/dL) after excluding 121 patients with elevated hs-CRP (≥0.5 mg/dL) from an initial cohort of 688.
Measured left carotid intima-media thickness using B-mode ultrasound and divided patients into lower and higher groups based on the median value.
Among 567 patients, 300 (52.9%) were assigned to the lower IMT group and 267 (47.1%) to the higher IMT group based on a median IMT of 0.76 mm.
Multivariable logistic regression demonstrated that higher IMT was significantly associated with CAD severity (1-vessel vs. 2-vessel: OR=1.711, 95% CI 1.134–2.580, p=0.010; 1-vessel vs. 3-vessel: OR=1.714, 95% CI 1.050–2.799, p=0.003).
Older age (~49 vs. 70~ years: OR=6.552, 95% CI 3.576–12.005, p<0.001) and elevated fasting blood glucose (~99 vs. 120~ mg/dL: OR=1.713, 95% CI 1.095–2.681, p=0.018) were also independently associated with higher IMT.

Study Design

Type

Cross-Sectional (n=567)

Multicenter

No

Structured PICO

Is increased left carotid intima-media thickness associated with the angiographic severity of coronary artery disease in patients with stable angina and normal hs-CRP levels?

P

Population

567 adults with stable coronary artery disease (>50% stenosis in at least one major coronary artery) and normal hs-CRP (<0.5 mg/dL), mean age 59.1 years, 45.0% female, evaluated in a single-center cross-sectional analysis.

E

Exposure

Higher left common carotid intima-media thickness (IMT >0.76 mm median, n=267 [47.1%]), measured via B-mode ultrasound (7.5-MHz linear transducer) at 3 sites on the far wall of the left common carotid artery prior to coronary angiography

C

Comparator

Lower left common carotid intima-media thickness (IMT <=0.76 mm median, n=300 [52.9%])

O

Outcome

Severity of coronary artery disease (1-vessel, 2-vessel, or 3-vessel disease defined by number of major coronary arteries with >50% stenosis on quantitative coronary angiography) and correlation with left carotid IMTsurrogate

Main Result

Odds Ratio: 1.714 (95% CI 1.05–2.799)

Absolute Event Rate: 16.5% vs 11.7%

p-value: p=0.003

In patients with stable angina and normal hs-CRP levels, increased carotid intima-media thickness (>0.76 mm) is independently associated with multivessel coronary artery disease and may serve as a simple non-invasive marker of CAD severity.

Limitations

Single-center, non-randomized study design
No comparison group with normal coronary arteries
Arbitrary division into two groups based on median IMT (0.76 mm) without an established cut-point
Lack of long-term follow-up for major adverse cardiovascular events (MACE)
Single-center, non-randomized study
Severity of CAD was evaluated only by number of diseased vessels
Did not include a control group with normal coronary arteries
Could not establish a definitive cut-point for carotid IMT, relying on the sample median (0.76 mm)
No long-term follow-up for major adverse cardiovascular events (MACE)

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Implication

Higher IMT was associated with multivessel CAD; leaves open its value for risk stratification beyond standard factors.

Abstract

Background: The purpose of this study was to determine whether hand-measured carotid intima-media thickness (IMT) was a reliable and simple tool that could be used to evaluate the severity of stable coronary artery disease (CAD) with normal high-sensitivity C-reactive protein (CRP). Material and Method: We examined left carotid IMTs in 688 patients with stable CAD and excluded 121 patients with abnormally elevated hs-CRP (≥0.5 ㎎/dL). We sought to determine the association between risk factors and the severity of stable CAD and carotid IMT in 567 patients who were divided into lower and higher groups based on the median value. Patients underwent a coronary artery angiogram and had at least significant stenosis (＞50% of the original luminal diameter involving one or more major coronary artery). Result: Of the 567 patients, 300 (52.9%) were in the lower IMT group and 267 (47.1%) were in the higher IMT group; the median value was 0.76 mm. By multivariable logistic regression analysis, the following groups were different: older age (~49 vs. 70~ years, respectively; OR=6.552), high FBS (~99 vs. 120~ ㎎/dL; OR=1.713) and severity of CAD (1 vessel vs. 2 vessel disease; OR=1.711, 1 vessel vs. 3 vessel disease; OR=1.714). Conclusion: We conclude that there are correlations between increased carotid IMT and severity of CAD in stable angina patients with normal CRP levels.

Discussion

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Cite This Study

Kwon et al. (2010) conducted a cross-sectional in Stable coronary artery disease with normal hs-CRP (n=567). Higher left carotid intima-media thickness (>0.76 mm median) vs. Lower left carotid intima-media thickness (<=0.76 mm median) was evaluated on 3-vessel coronary artery disease (vs 1-vessel disease) (OR 1.714, 95% CI 1.050-2.799, p=0.003). Higher carotid intima-media thickness (>0.76 mm) was independently associated with 3-vessel CAD (OR 1.714, 95% CI 1.050-2.799, p=0.003) and 2-vessel CAD (OR 1.711, p=0.010) in stable angina.

synapsesocial.com/papers/6ae8eab1046ae126149f069e https://doi.org/10.5090/kjtcs.2010.43.5.482

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The Clinical Value of Intima-media Thickness in Patients with Stable Coronary Artery Disease and C-reactive Protein within Normal Limits

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Clinical Value of Intima-media Thickness in Patients with Stable Coronary Artery Disease and C-reactive Protein within Normal Limits

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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