ROLE OF RISK FACTORS IN PREDICTION OF ASYMPTOMATIC CAROTID ARTERY STENOSIS IN PATIENTS WITH CORONARY ARTERY DISEASE

BILJANA OBRENOVIC-KIRCANSKI¹,², DRAGAN PANIC² , BILJANA PARAPID² , RADMILA KARAN³ , NATASA KOVACEVIC-KOSTIC³ , LJILJANA SKORIC-HINIC² , DEJAN NIKOLIC⁴ , DRAGAN VASIC⁶ , MILE VRANES¹,⁵, MILOS VELINOVIC¹,⁵

¹ Faculty of Medicine, University of Belgrade, Belgrade - ² Division for Cardiology, Clinical Center of Serbia, Belgrade - ³ Center for Anesthesiology, Clinical Center of Serbia, Belgrade - ⁴ Physical Medicine and Rehabilitation Department, University Children’s Hospital, Belgrade - ⁵Division for Cardiac Surgery, Clinical Center of Serbia, Belgrade - ⁶ Division for Vascular Surgery, Clinical Center of Serbia, Belgrade, Serbia

Aims: To determine the frequency of asymptomatic carotid artery stenosis in patients with coronary artery disease and to what degree the extent of coronary artery disease and presence of certain risk factors can be indicators of carotid artery stenosis in asymptomatic patients.

Material and methods: Retrospective evaluation of consecutive patients that underwent coronary artery bypass grafting (CABG) during one year without symptoms or signs of carotid artery stenosis. The pre-operative Doppler ultrasonography in color and B-mode, using Siemens Accuson Antares machine, was used to determine the presence and the degree of carotid artery stenosis. Patients were divided according to the presence of significant (≥50%) carotid artery stenosis. The same doctor performed all examinations. Following variables were analysed: age, gender, body mass index, hypertension, diabetes, smoking, cholesterol, triglycerides and echocardiographic variables obtained from transthoracic echocardiography - the presence of aortic wall sclerosis, aortic valve sclerosis and mitral valve calcification.

Results: We have demonstrated that in 18/272 (7.1%) of patients referred to CABG with hemodynamically significant carotid artery stenosis had asymptomatic stenosis. The risk of presence of carotid artery stenosis was more significant in those older than 60 years (OR 2.58; 95% CI 0.98-6.77, p=0.047) and in patients with left main coronary artery stenosis (OR 8.92; 95% CI 3.2-24.83, p<0.001). Other investigated variables had no significant influence (p>0.05). Conclusion: The presence of asymptomatic carotid artery stenosis is strongly associated with the presence of left main coronary artery stenosis and with age older than 60 years. Noninvasive screening for carotid disease is reasonable in these subgroups of patients referred to CABG.