(Circulation. 1995;92:2127-2134.)
© 1995 American Heart Association, Inc.
Articles |
Carotid Intima-Media Thickness Is Only Weakly Correlated With the Extent and Severity of Coronary Artery Disease
From the Department of Cardiology (M.R.A., A.N., A.K., J.R., R.M., B.P.B., S.B.F., D.S.C.), Royal Prince Alfred Hospital; The Heart Research Institute (J.R., R.M., D.S.C.); and The NHMRC Clinical Trials Centre (A.K.), University of Sydney (Australia).
Correspondence to Dr David S. Celermajer, Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown 2050, Sydney, Australia.
Background Intima-media thickness (IMT) of the common carotid artery (CCA), measured with external vascular ultrasound, has been widely used in clinical trials as a surrogate marker for coronary atherosclerosis. Despite this, the degree of correlation between carotid IMT and the extent and severity of coronary artery disease (CAD) is not known.
Methods and Results Common carotid IMT was measured by ultrasound
in 350 consecutive subjects of age 60±10 years (range, 30 to 85 years)
on the day of coronary angiography. Carotid mean IMT was
0.83±0.20 mm (range, 0.43 to 1.80 mm), and maximum IMT was 1.04±0.27
mm (range, 0.49 to 2.19 mm). Coronary angiograms were
analyzed by independent observers for disease severity (number
of vessels with 
70% stenosis), extent score, and a modified
Gensini score. Mean carotid IMT was weakly but significantly correlated
with CAD severity (r=.26), extent (r=.23), and
modified Gensini score (r=.29, P<.0001 for all
correlations). Carotid IMT was not clinically useful, however, because
it was not specific or sensitive enough to identify patients with or
without significant CAD. Increasing age, male sex, and presence of
diabetes were all associated with a significantly (P<.01)
higher CAD score than the average for any level of carotid IMT,
suggesting differential effects of these traditional risk factors on
the coronary and common carotid arteries.
Conclusions Although carotid IMT is significantly correlated with extent and severity of CAD, the relationship is weak. This relatively poor correlation (r2<.10) should be considered in the interpretation of clinical trials that use carotid IMT as a surrogate end point for coronary atherosclerosis.
Key Words: arteries • ultrasonics • atherosclerosis
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