Lepek Johanna, Linnebank Michael, Bansemir Lars, Kloppe Axel
Medical Clinic, Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany.
Faculty of Health, University Witten/Herdecke, 58455 Witten, Germany.
J Clin Med. 2025 Mar 29;14(7):2366. doi: 10.3390/jcm14072366.
There is a large overlap in the risk profiles and pathophysiologies of coronary artery disease (CAD) and cerebrovascular macroangiopathy. Therefore, this study aimed to analyse whether findings in CAD examination by coronary angiography or cardio-computer tomography (cardio-CT) are predictive of cerebrovascular macroangiopathy. Our study was a prospective, bicentric, cross-sectional cohort study. A total of 191 patients without earlier CAD diagnosis who underwent a cardio-CT scan or coronary angiography for the screening of CAD during clinical routine were serially included. Two groups were formed based on the criterion of CAD (yes/no), and both were subsequently examined using sonography of the carotids. The CAD scores Syntax score I, Agatston equivalent score, and CAD-RADS score as well as AHA classification were determined. In cerebrovascular examinations, plaques and stenoses of the internal carotid artery (ICA) and the intima-media thickness (IMT) of the common carotid artery were analysed. Demographic and medical data such as the presence of arterial hypertension, diabetes mellitus, obesity, nicotine abuse, and dyslipidaemia were documented. The primary endpoint was the nominal association between CAD and ICA stenosis controlled for age and gender; secondary endpoints were correlations between ICA stenoses and CAD scores. Of the 191 serially recruited patients (58% male, 65 ± 11 yrs.), 101 fulfilled CAD criteria; 90 did not. Of all patients, 137 had ICA plaques, and 11 thereof had an ICA stenosis ≥ 50%. No association was found between CAD and ICA stenosis (Wald = 0.24; = 0.624). Accordingly, there was no association between IMT and Syntax score I (Wald = 0.38; = 0.706), Agatston equivalent score (Wald = 0.89; = 0.380), CAD-RADS score (Wald = 0.90; = 0.377), or AHA classification (Wald = 0.21; = 0.837). Common cardiovascular risk factors, i.e., arterial hypertension (Wald = 4.47; = 0.034), diabetes mellitus (Wald = 7.61; = 0.006), and nicotine abuse (Wald = 0.83; = 0.028), were associated with newly diagnosed CAD but not with ICA plaques, stenosis, or increased IMT. In our cohort, newly diagnosed CAD was associated with typical risk factors. However, neither CAD nor these risk factors were associated with cerebrovascular disease. This suggests that in patients without prior CAD diagnosis, findings from CAD examinations might not be reliably predictive of cerebrovascular disease.
冠状动脉疾病（CAD）和脑血管大血管病变在风险概况和病理生理学方面存在很大重叠。因此，本研究旨在分析冠状动脉造影或心脏计算机断层扫描（心脏CT）在CAD检查中的结果是否可预测脑血管大血管病变。我们的研究是一项前瞻性、双中心、横断面队列研究。共有191例既往未诊断为CAD的患者在临床常规检查中接受了心脏CT扫描或冠状动脉造影以筛查CAD，并被连续纳入研究。根据CAD标准（是/否）分为两组，随后两组均接受颈动脉超声检查。确定CAD评分（Syntax评分I、阿加斯顿等效评分和CAD-RADS评分）以及美国心脏协会（AHA）分类。在脑血管检查中，分析颈内动脉（ICA）的斑块和狭窄以及颈总动脉的内膜中层厚度（IMT）。记录人口统计学和医学数据，如动脉高血压、糖尿病、肥胖、吸烟和血脂异常的存在情况。主要终点是在控制年龄和性别的情况下CAD与ICA狭窄之间的名义关联；次要终点是ICA狭窄与CAD评分之间的相关性。在191例连续招募的患者中（58%为男性，年龄65±11岁），101例符合CAD标准；90例不符合。在所有患者中，137例有ICA斑块，其中11例ICA狭窄≥50%。未发现CAD与ICA狭窄之间存在关联（Wald=0.24；P=0.624）。因此，IMT与Syntax评分I（Wald=0.38；P=0.706）、阿加斯顿等效评分（Wald=0.89；P=0.380）、CAD-RADS评分（Wald=0.90；P=0.377）或AHA分类（Wald=0.21；P=0.837）之间均无关联。常见的心血管危险因素，即动脉高血压（Wald=4.．47；P=0.034）、糖尿病（Wald=7.61；P=0.006）和吸烟（Wald=0.83；P=0.028）与新诊断的CAD相关，但与ICA斑块、狭窄或IMT增加无关。在我们的队列中，新诊断的CAD与典型危险因素相关。然而，CAD和这些危险因素均与脑血管疾病无关。这表明，在既往未诊断为CAD的患者中，CAD检查结果可能无法可靠地预测脑血管疾病。
