Carotid Evaluation in Patients with Suspected Coronary Disease: Is There a Negative Prediction?

Abstract

Introduction

Due to its prevalence and gravity, coronary diseases require a more definite and early sort of diagnosis. Thus, there is extreme urgency in identifying patients under the risk of such problem. The most important indicator of risk is a previous manifestation of atherosclerosis itself. In this context, the study of subclinical atherosclerosis may bring to light essential information.

Objective

To evaluate if there is any connection between carotid and coronary alterations; if the absence of atherosclerosis in the arterial bed may indicate absence of obstructive atherosclerotic disease in the coronary bed; and if the absence of carotid lesion might substantiate the non indication of coronarography, keeping in mind the clinical characteristics of each patient.

Methods

This study was observational, transversal, analytic and comparative. Fifty consecutive patients were included, having clinical indication for coronarography. A vascular ultrasound exam of the carotids was performed for a comparison of the results.

Results

All patients with no carotid plaque, evaluated using vascular ultrasound, did not present any significant coronary obstruction, as evaluated via coronarography. All patients who showed significant carotid obstruction, ≥ 50%, also presented significant coronary obstruction, ≥ 70%. Among the evaluated points, only the result of the vascular ultrasound exam of the carotids was seen as a risk predictor in the findings obtained via vascular ultrasound (odds ratio of 2,58; confidence interval 1,66-4,02; p < 0,001).

Conclusion

There was a positive association between the degree of the atherosclerotic lesion of the carotid and of the coronary. No patient without carotid lesion showed significant obstruction of coronary artery, presenting high negative predictive value.