颈动脉粥样硬化与冠状动脉疾病的关联：胸痛患者中颈动脉超声检查与冠状动脉造影的比较

[Association of carotid atherosclerosis with coronary artery disease: comparison between carotid ultrasonography and coronary angiography in patients with chest pain].

作者信息

Novo Salvatore, Corrado Egle, Novo Giuseppina, Dell'Oglio Sonia

机构信息

Centro per la Diagnosi Precoce di Aterosclerosi Preclinica, UOC di Cardiologia, Palermo.

出版信息

G Ital Cardiol (Rome). 2012 Feb;13(2):118-23. doi: 10.1714/1021.11145.

DOI:10.1714/1021.11145

PMID:22322552

Abstract

BACKGROUND

Several studies have shown that the risk of cardiovascular events is higher in subjects with ultrasound evidence of subclinical carotid atherosclerosis. The aim of our study was to demonstrate the correlation between carotid atherosclerosis and severity of coronary artery disease in patients with typical chest pain who performed Doppler ultrasound of carotid arteries and diagnostic coronary angiography during hospitalization.

METHODS

We studied 210 patients admitted to our cardiology unit for chest pain. Inclusion criteria were the presence of typical chest pain on admission to the emergency room and the performance of diagnostic coronary angiography and Doppler ultrasound examination of carotid arteries during hospitalization. Patients with positive biomarkers of myocardial infarction on admission to the emergency room and patients with a positive medical history for cardio- and cerebrovascular disease were excluded.

RESULTS

Carotid ultrasound examination showed a 10% prevalence of normal carotid arteries, a 37% prevalence of intima-media carotid thickness and a 53% of asymptomatic carotid plaques. Coronary angiography showed that 29% of patients had normal coronary arteries, 26% had a coronary disease localized in a single vessel, 18% in two vessels, whereas 27% showed the involvement of three vessels. The presence of a normal carotid intima-media thickness was predominantly associated with the presence of angiographically normal coronary arteries (p=0.006), whereas the detection of asymptomatic carotid plaques at ultrasound examination was significantly correlated with three-vessel coronary artery disease (p=0.01). At logistic regression analysis, carotid atherosclerosis was predictive of severe coronary artery disease (odds ratio 2.1, 95% confidence interval 1.1-4.2, p=0.01).

CONCLUSIONS

Given the significant correlation between the presence of preclinical carotid atherosclerosis and severity of coronary artery disease, the evaluation of carotid intima-media thickness might provide additional information for a more accurate determination of cardiovascular risk.

摘要

背景

多项研究表明，有超声证据显示存在亚临床颈动脉粥样硬化的受试者发生心血管事件的风险更高。我们研究的目的是在因典型胸痛住院期间接受颈动脉多普勒超声检查和诊断性冠状动脉造影的患者中，证明颈动脉粥样硬化与冠状动脉疾病严重程度之间的相关性。

方法

我们研究了210名因胸痛入住我们心脏病科的患者。纳入标准为急诊入院时存在典型胸痛，以及住院期间进行诊断性冠状动脉造影和颈动脉多普勒超声检查。排除急诊入院时心肌梗死生物标志物阳性的患者以及有心血管和脑血管疾病阳性病史的患者。

结果

颈动脉超声检查显示，颈动脉正常的患病率为10%，内膜中层颈动脉厚度的患病率为37%，无症状颈动脉斑块的患病率为53%。冠状动脉造影显示，29%的患者冠状动脉正常，26%的患者冠状动脉疾病局限于单支血管，18%的患者累及两支血管，而27%的患者显示三支血管受累。颈动脉内膜中层厚度正常主要与冠状动脉造影正常相关（p = 0.006），而超声检查发现无症状颈动脉斑块与三支血管冠状动脉疾病显著相关（p = 0.01）。在逻辑回归分析中，颈动脉粥样硬化可预测严重冠状动脉疾病（比值比2.1，95%置信区间1.1 - 4.2，p = 0.01）。