The carotid intima-media thickness as a marker of the presence of severe symptomatic coronary artery disease

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Abstract
High resolution ultrasound can be used for the accurate measurement of intima-media thickness (IMT). The within-observer coefficient of variation of the IMT of two carotids measured seven times each on different days by two different observers was between 4% and 8%, and the mean absolute difference of the IMT of 68 carotids measured independently by two observers was 0.11 ± 0.11 mm (mean value ± SD). Seventy-five consecutive male patients who underwent coronary angiography for assessment of chest pain and 40 normal controls matched for age and sex, were examined with high resolution B-mode ultrasound. The IMT of the common carotid artery for the controls was 0.71 ± 0.16 mm and for the patients 0.91 ± 0.18 mm (P<0.005). In patients with normal coronary angiogram the IMT was 0.73 ± 0.1 mm, and this increased in each of the subgroups with coronary stenosis compared to patients who had a normal coronary angiogram. In the group with one-vessel disease it was 0.9± 0.17 mm (P<005, ANOVA), in the group with two-vessel disease it was 0.96 ± 0.17 mm (P<0.01), and in the group with three-vessel disease it was 0.99 ± 0.21 mm (P<0.01). There was a significant linear trend between IMT and the number of involved vessels (P0.85 mm was derived from the studied population of 75 patients as a criterion for the prediction of coronary artery disease (CAD). This criterion was prospectively evaluated in a further group of 32 consecutive patients, in whom it could predict the presence of CAD with a specificity of 77%, a sensitivity of 43% and a positive predictive value of 83%. Thus, an increased carotid IMT is a marker of coronary vascular disease which can be measured non-invasively and may be used as a biological marker of CAD in observational studies and clinical trials. In addition, an increased IMT may have considerable importance as a screening tool for coronary atheroma.

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