Femoral rather than carotid artery ultrasound imaging predicts extent and severity of coronary artery disease

Background: Pathological, epidemiological and clinical studies indicate that there is coexistence between peripheral vascular disease and coronary artery disease (CAD). B-mode ultrasound of superficial arteries is a non-invasive, valid and reproducible method of directly visualising and assessing carotid and femoral intima-media thickness (IMT) and focal atherosclerosis. Aim: To evaluate the prognostic importance of carotid and femoral vascular changes in predicting CAD severity. Methods: 410 patients - 300 (73.2%) males and 110 (26.8%) females - aged 29-75 years (mean age 55.9 +/- 9.5 years), referred for elective coronary arteriography, were studied. Clinical examination and laboratory tests were performed, and ultrasound assessments of IMT and atherosclerotic plaque thickness in the common carotid arteries and common femoral arteries were evaluated. Results: Coronary angiography revealed CAD in 81% of patients (85% of males, 70% of females). Cox multiple hazards regression analyses showed a significant relationship between size of atherosclerotic plaques in peripheral arteries and CAD. Odds ratio of CAD associated with every 1-mm plaque thickening ranged from 1.7 to 3.0 (p <0.001) depending on examined artery. Using multiple stepwise regression analysis, the following parameters were found to be independent predictors of one-vessel CAD: myocardial infarction (MI) in anamnesis (OR=22.3; 95% CI 4.0-122.9), typical chest pain (OR=6.4; 95% CI 1.2-34.2), femoral IMT (OR=5.0; 95% CI 1.4-18.4), ex-smoking (OR=5.6; 95% CI 1.1-28.7), and pulse pressure (OR=1.8; 95% CI 1.0-3.2). Independent predictors of multi-vessel CAD were: MI (OR=3.7; 95% CI 1.8-7.5), typical angina (OR=3.3; 95% CI 1.7-6.5), age (OR=1.05; 95% Cl 1.01-1.08), number of cigarettes smoked (OR=0.8; 95% CI 0.6-0.9), total cholesterol level (OR=1.1; 95% CI 1.0-1.2), and left femoral plaque thickness (OR=1.4; 95% CI 1.0-2.0). Conclusion: Femoral IMT is an independent predictor of a single-vessel disease, whereas femoral atherosclerotic plaque presence indicates advanced CAD.