Holaj Robert, Spacil Jiri, Petrasek Jan, Malik Jan, Haas Tomas, Aschermann Michael
General University Hospital, Prague, Czech Republic.
Can J Cardiol. 2003 May;19(6):670-6.
Previous studies have shown a relationship between intima-media thickness (IMT) of the common carotid artery and coronary artery disease (CAD). The role of IMT in the prediction of significant CAD has not been established.
To investigate the diagnostic accuracy of IMT measurement and the detection of carotid plaques in relation to cardiovascular risk factors in the prediction of significant CAD.
One hundred and seventy patients (121 men and 49 women; average age 58 +/- 11 years) undergoing selective coronary angiography were examined by carotid ultrasound. IMT was measured. Plasma lipid concentrations and other risk factors were determined.
Angiographically proven significant CAD was found in 138 (81%) of all patients. Carotid plaques were detected in 98 (58%) of all patients. Presence of carotid plaques in common carotid artery (P<0.001) and male sex (P<0.005) were found to be categorical risk factors for significant CAD but in multiple regression analysis only age (P=0.15), IMT (P<0.01), high density lipoprotein (HDL) cholesterol (P=0.02) and, less significantly, total cholesterol (P=0.09) were found to be independent parameters for the prediction of significant CAD. IMT of 0.75 mm was determined as a cut-off point for the detection of significant CAD (sensitivity 78%, specificity 79%, positive predictive value 95%, negative predictive value 41%, odds ratio 12.9, 95% CI 3.5 to 47.6).
The increase in IMT is the significant positive predictor of angiographically proven CAD; other predictors are high age, low HDL cholesterol and, less significantly, high total cholesterol. Presence of carotid plaques and male sex do not add any new information for the prediction of CAD once the predictors are considered.
既往研究表明，颈总动脉内膜中层厚度（IMT）与冠状动脉疾病（CAD）之间存在关联。IMT在预测严重CAD中的作用尚未明确。
探讨IMT测量及颈动脉斑块检测在预测严重CAD中与心血管危险因素相关的诊断准确性。
对170例接受选择性冠状动脉造影的患者（121例男性和49例女性；平均年龄58±11岁）进行颈动脉超声检查。测量IMT。测定血浆脂质浓度及其他危险因素。
所有患者中，经血管造影证实有严重CAD的有138例（81%）。所有患者中有98例（58%）检测到颈动脉斑块。发现颈总动脉存在颈动脉斑块（P<0.001）和男性（P<0.005）是严重CAD的分类危险因素，但在多因素回归分析中，仅年龄（P=0.15）、IMT（P<0.（此处原文有误，推测应为P<0.01））、高密度脂蛋白（HDL）胆固醇（P=0.02）以及不太显著的总胆固醇（P=0.09）被发现是预测严重CAD的独立参数。IMT为0.75mm被确定为检测严重CAD的切点（敏感性78%，特异性79%，阳性预测值95%，阴性预测值41%，优势比12.9，95%可信区间3.5至47.6）。
IMT增加是经血管造影证实的CAD的显著阳性预测指标；其他预测指标为高龄、低HDL胆固醇以及不太显著的高总胆固醇。一旦考虑了这些预测指标，颈动脉斑块的存在和男性性别在预测CAD方面并未增加任何新信息。
