A Negative Carotid Plaque Area Test Is Superior to Other Noninvasive Atherosclerosis Studies for Reducing the Likelihood of Having Underlying Significant Coronary Artery Disease

Abstract

Objective-Coronary calcium score (CCS), carotid plaque area (CPA), intima-media thickness (IMT), and C-reactive protein (CRP) are independent predictors of cardiovascular prognosis. Although each test may enhance risk stratification, their comparative abilities to screen for underlying coronary stenoses in individual patients is less established. Methods and Results-Forty-two patients who had a 16-slice coronary computed tomography angiogram (CTA) performed were invited to have CPA, IMT, and CRP measured. CPA was defined as the sum of all the cross-sectional areas of each plaque Ͼ1 mm in diameter found in all carotid vessels bilaterally. CCS and the number plus degree of stenotic coronary arteries were determined by CTA. The presence of clinically significant coronary artery disease (CAD) was defined as the existence of any stenosis Ն50%. CTA identified clinically significant CAD in 43% of the patients. CPA Ͼ0 was more sensitive (72%) and specific (58%) than a CCS Ͼ0 (58% and 55%) for identifying CAD. A "clean" carotid artery (CPAϭ0) provides a superior negative predictive value (74%) and likelihood ratio of a negative test (0.48) than all other studies, in particular versus a CCSϭ0 (65% and 0.72). The areas under the receiver-operator curves for CPA and CCS in relation to any CAD were similar (0.640 versus 0.675). Carotid IMT and CRP performed poorly compared with CPA and CCS. For detecting CAD in only the left main or left anterior descending artery, the negative predictive value and likelihood ratio of a negative test remained superior for CPA (87% and 0.33) compared with CCS (80% and 0.56). In our population with a prevalence of these coronary lesions of 30%, the post-test probability in any patient with a negative CPA result is reduced to 10%. Conclusion-CPA determination is superior to CCS, IMT, and CRP in its ability to reduce the likelihood of clinically significant underlying CAD in patients of varying cardiac risk.

Carotid plaque, a subclinical precursor of vascular events

“…Several studies have provided evidence that carotid plaque predicts MI better than IMT. 14,31,35 It is also important to note, however, that many studies included plaque in the measurement of carotid IMT. [11][12][13][14]38 In some, the IMT measurement was dichotomized above and below a threshold level of IMT, which produced the effect of pooling subjects with plaques into the higher IMT level group because plaques tend to be more common in those with a thicker IMT.…”

Impact of Combined Assessment of Coronary Artery Calcium Score, Carotid Artery Plaque Score, and Brachial-Ankle Pulse Wave Velocity for Early Coronary Revascularization in Patients With Suspected Coronary Artery Disease

“…Previous studies demonstrated that presence of carotid plaque was a more powerful predictor of cardiovascular events than intima-media thickness. [21][22][23][24] Carotid plaque score is useful as a means of semiquantitative analysis of degree of atherosclerosis. CPS is obtained by a wider range observation of the carotid arteries than intima-media thickness.…”

Proinsulin:insulin and insulin:glucose ratios as predictors of carotid plaque growth: a population-based 7 year follow-up of the Tromsø Study

“…IMT primarily represents medial hypertrophy related to hypertension [24,25], and the association between IMT and CHD was weak in several studies [26,27]. CPA was claimed to be a better predictor of coronary atherosclerosis than other noninvasive methods [11,28]. CPA was also shown to be more sensitive than IMT for early detection of atherosclerosis [29].…”