ORIGINAL ARTICLE  CAROTID DISEASE Free access

International Angiology 2019 August;38(4):312-9

DOI: 10.23736/S0392-9590.19.04094-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Prevalence and risk factors of subclinical coronary artery disease in patients undergoing carotid endarterectomy: a retrospective cohort study

Hiroyuki NAKAJIMA ✉, Tomoyasu MOMOSE, Takuo MISAWA

Department of Cardiology, Nagano Matsushiro General Hospital, Nagano, Japan

BACKGROUND: Coronary artery disease (CAD) is closely associated with carotid artery stenosis in the context of systemic arteriosclerosis, and it is a known perioperative risk factor for carotid endarterectomy (CEA). We aimed to evaluate the prevalence and risk factors of subclinical CAD in patients without known CAD undergoing CEA.
METHODS: This was a single-center, retrospective, observational study conducted between January 2013 and December 2016. Among the patients scheduled for elective CEA, 69 with no medical history of CAD and no clinical symptoms (mean age, 76.4±7.8 years; 71.0% men) underwent coronary computed tomography (CT). Coronary angiography (CAG) and subsequent fractional flow reserve (FFR) estimation were performed if necessary. Subclinical CAD was defined as newly found significant coronary lesions after coronary CT screening. Significant coronary lesions were defined as lesions that showed total or subtotal occlusion on coronary CT, had ≥75% stenosis on CAG, or had FFR≤0.80 in major coronary arteries.
RESULTS: The prevalence of subclinical CAD was 17.4% (12 of 69 patients). Among the patient characteristics assessed, only high-density lipoprotein cholesterol (HDL-C) levels were significantly different between patients with and those without subclinical CAD (45.8±10.1 vs. 59.7±16.7 mg/dL, P=0.0072). A multivariate analysis revealed that low HDL-C levels were independent risk factors for subclinical CAD after adjusting for possible confounders (adjusted odds ratio: 0.91, 95% confidence interval: 0.84-0.98, P=0.0099).
CONCLUSIONS: Subclinical CAD is a common finding and is associated with low HDL-C in patients without known CAD undergoing CEA.

KEY WORDS: Coronary artery disease; Carotid stenosis; Endarterectomy, carotid; Myocardial ischemia; Cholesterol, HDL