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(Chest. 2005;128:2538-2543.)
© 2005 American College of Chest Physicians

Association of Subclinical Wall Changes of Carotid, Femoral, and Popliteal Arteries With Obstructive Coronary Artery Disease in Patients Undergoing Coronary Angiography*

Alexandros Kafetzakis, MD; George Kochiadakis, MD; Aggelos Laliotis, MD; Ioannis Peteinarakis, MD; Emmanouel Touloupakis, MD; Nikos Igoumenidis, MD and Asterios Katsamouris, MD

* From the Vascular Surgery Department (Drs. Kafetzakis, Laliotis, Touloupakis, and Katsamouris), Department of Cardiology (Drs. Kochiadakis and Igoumenidis), and Department of Radiology (Dr. Peteinarakis), University Hospital of Heraklion, University of Crete Medical School, Crete, Greece.

Correspondence to: Asterios Katsamouris, MD, Professor of Vascular Surgery, University of Crete Medical School, PO Box 1352, Heraklion, Crete, Greece; e-mail: asterios{at}med.uoc.gr

Study objectives: To examine the association of occult atherosclerosis of carotid, femoral, and popliteal arteries with the presence and severity of obstructive coronary artery disease (CAD) in patients without a history or presence of cerebrovascular or peripheral arterial disease using ultrasound examination of peripheral arteries.

Patients/methods: One hundred eighty-four such individuals underwent routine coronary angiography. Obstructive CAD was found in 103 cases, which comprised the patient group. The remaining 81 individuals comprised the control group. All were blindly examined by duplex ultrasonography in order to assess occult atherosclerosis, as indicated by the estimation of intima-media thickness of the carotid artery (IMTC), intima-media thickness of the femoral artery (IMTF), intima-media thickness of the popliteal artery (IMTP), and ultrasonic biopsy (UB) of the carotid and femoral arteries. For the individuals with positive coronary angiography findings, the severity of CAD was estimated by the number of the diseased vessels.

Results: IMTC, IMTF, IMTP, and UB showed significant correlation with the presence of obstructive CAD, but only IMTC and IMTF were independent predictive factors, with specificity of 74% and 60% and sensitivity of 76% and 70%, respectively. Additionally, our analysis yielded a regression model that, for a given value of IMTC and IMTF, may estimate the probability of CAD: p (CAD) = e(– 4.765 + 3.36 IMTC + 1.91 IMTF)/1 + e(– 4.765 + 13.36 IMTC + 1.91 IMTF). Patients with one-vessel disease had significantly lower IMTC (p < 0.001) and UB (p = 0.011) and lower IMTF (p = 0.057) than those with three-vessel disease.

Conclusions: The assessment of occult atherosclerosis by duplex ultrasonography in both the carotid and the femoral arteries is significantly associated with the presence and severity of CAD.

Key Words: coronary artery disease • intima-media thickness • occult atherosclerosis • peripheral arterial disease • ultrasonic biopsy






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