The Value Of Parameter Of Carotid Artery Plaque In Screening Suspected Coronary Artery Disease

Backgrounds and ObjectivesEarly identification of CAD is extremely important to reduce malignant cardiovascular events,and its diagnosis depends on coronary angiography(CAG),which is unsuitable as a screening tool for its expensive,invasive,and carries potential risks of radiation and renal injury.In recent guidelines,it is emphasized to perform the pre-test probability(PTP)estimated by the updated diamond Forrest method and Duke method to guide CAG examination,so as to improve the positive rate of CAG diagnosis.To date,the Duke(Duke clinical score,DCS)and diamond Forrest clinical scores(updated diamond Forrest Method,UDFM)are the most widely used model for the diagnosis of CAD,but several related observational studies suggested that the value of both prediction models are modest due to the lack of accuracy and the gender differences in the patients referred for CAG.Therefore,it is hard to judge that which clinical characteristics of the population are most suitable for performing CAG examination.It is well known that atherosclerosis is a systemic disease,and the carotid artery is an ideal window of visualization for systemic arteriosclerosis,which can be clarified using carotid ultrasound that is a noninvasive,convenient,and secure method to examine carotid atherosclerosis widely and effectively.However,which parameter in carotid ultrasound is more satisfied to predicting CAD remains inconclusive.Therefore,we hypothesized that the total plaque length(TPL)of carotid artery could be used as an effective indicator in the parameters of carotid artery plaque,which could reclassify the population with suspected CAD more objectively and accurately,and then provide strong evidence for performing invasive examination.Materials and MethodsA total of consecutive of 658 patients who were hospitalized with chest pain in the Cardiovascular Department of the First Affiliated Hospital of Zhengzhou University from June 2018 to January 2019 were collected,and 298 objects were enrolled finally in this study on account of exclusion criteria.The basic data,carotid artery ultrasound parameters(US)and coronary angiography(CAG)results of objects were recorded.The patients were divided into coronary artery disease group(CAD)and non-coronary artery disease group(No CAD)according to the results of CAG.We compare the difference between CAD group and No CAD group in terms of carotid artery plaque parameters.The correlation between GS and the total plaque length(TPL),maximum plaque length(MPL),total plaque height(TPH)and maximum plaque height(MPH)were evaluated.The ROC of plaque parameters was calculated,and the AUC was determined to estimate the optimal cut-off value of plaque parameters for predicting the existence and the severity of CAD.Logistics regression analysis was performed to identify the risk factors of CAD existence and severity.Finally,building and selecting the best prediction model for predicting CAD.Results1.Comparison of general data between two groups:Compared with no CAD group,CAD group had older age(P=0.016),higher prevalence of hypertension(P=0.008),diabetes(P=0.001),higher levels of blood glucose(P=0.036),glycosylated hemoglobin(P=0.010),creatinine(P=0.017),lower levels of HDL-C(P=0.009),EGFR(P=0.005),higher GS score(P<0.001),and larger plaque parameters(P<0.001).2.Correlation analysis:Spearman’s rank correlation coefficient was used to evaluate the correlation between plaque parameters and GS.It was found that TPL had the strongest correlation with GS(rs=0.466),followed by TPH(rs=0.456)and MPL(rs=0.413),while MPH(rs=0.340)had the weakest correlation with GS.3.Multivariate analysis:The results of multivariate analysis showed that TPL,TPH,MPL and MPH were associated with CAD,and TPL and TPH were associated with multivessel disease of CAD.4.Analysis of predictive models:It was found that the four new models had significantly better discrimination and reclassification ability for CAD compared with TRF model(P<0.05).Specifically,the new model consist of TPL and TRF had the highest incremental value of both the discrimination and reclassification for CAD(AUC=0.824,NRI=14.58%)and multivessel disease of CAD(AUC=0.789,NRI=18.95%).It is worth noting that only the new model comprising TPL and TRF was significant differences compared with TRF model(P=0.0077).Conclusion1.Among the carotid parameters,TPL and GS have the closest correlation,which can be more accurate to reflect coronary artery stenosis in patients with suspected CAD;2.TPL can be used as an effective indicator of CAD screening by significantly improving the value of discrimination and reclassification.