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Comparison between Carotid Artery Doppler Ultrasound and Coronary Calcium Score as Predictors of Significant Coronary Artery Disease in Patients Undergoing Computed Tomography Coronary Angiography

Silvia Tresoldi, Riccardo Bigi, Dario Gregori, Anna Ravelli, Paola Pricolo, Nicola Flor, Sergio Papa and Gianpaolo Cornalba

Background: The association between carotid artery Doppler ultrasound (US) or coronary Calcium Score (CCS) and the presence of significant CAD has been suggested but not largely documented. The purpose of this study was to compare carotid artery Doppler US and CCS as predictors of significant CAD.

Methods: 56 patients (47 males, mean age 62 ± 8 years) with no history of CAD, who had undergone computed tomography coronary angiography (CTCA), Calcium Score evaluation and US, entered the study. Distribution of main socio-demographic and health related characteristics were described. On the basis of the CTCA results patients were classified as with no/non-significant CAD or with significant CAD. The presence of carotid plaques and the intima-media thickness (IMT) value were assessed with US stratifying patients into 3 groups: IMT ≤ 0.5 mm (free from disease); IMT 0.6-1mm (non-significant disease); IMT >1 mm (significant disease). Volume, Mass and Agatston Score were calculated using computed tomography (CT). Considering Agatston Score absolute values patients were classified into 5 groups: Agatston Score <10; 10-99; 100-399; 400-999; ≥ 1000; on the basis of risk percentiles patients were classified into 4 groups: <25° percentile, <50° percentile, <75° percentile, >75° percentile. Association between Calcium Score and IMT with CAD at CTCA were assessed.

Results: Age, gender, hypertension, diabetes, high blood cholesterol, familiar history of CAD and smoke habit were similar in patients with and without significant CAD, whilst chest pain was significantly (p=0.001) associated with CAD. At univariate analysis, IMT (p=0.001) and Calcium Score (p<0.001) were associated with significant CAD. However, after adjusting for potential confounders, multivariate analysis indicated Calcium Score as the only significant and independent predictor of significant CAD.

Conclusion: Calcium Score is a more powerful marker of significant CAD compared to atherosclerotic burden of the carotid artery.