Usefulness in predicting coronary artery disease by ultrasonic evaluation of the carotid arteries in asymptomatic hypercholesterolemic patients with positive exercise stress tests

A positive exercise electrocardiogram (ECG) is not infrequent occurrence in asymptomatic hypercholesterolemic patients, but the number of false-positi ve rests may be relatively high (50%), Therefore, the ability of a positive stress ECG to predict coronary artery lesions is low even in populations w ith greater than or equal to 1 cardiovascular risk factors. To increase the diagnostic value of exercise tests for screening asymptomatic individuals, we analyzed whether combined clinical parameters with carotid echography w ould accurately predict coronary atherosclerotic lesions by coronary angiog raphy in asymptomatic hypercholesterolemic patients with a positive exercis e EGG, Seventy-six asymptomatic patients (between 35 and 65 years of age) w ith hypercholesterolemia (total plasma cholesterol >6.5 mmol/l or 250 mg/dl ) and a positive stress ECG were referred for carotid B-mode echography and coronary angiography. Carotid echography data were divided into 2 categori es: (1) absence of any atherosclerotic plaque, or (2) presence of greater t han or equal to 1 arterial plaques, Coronary stenosis assessed by coronary angiography was considered to correspond to a greater than or equal to 50% reduction of coronary lumen diameter. Forty-three patients (57%) displayed coronary lesions; most (38; 88%) had carotid plaque. Multivariate analysis showed that the presence of carotid plaque was significantly associated wit h coronary stenosis (odds ratio 15.2; confidence interval 5.0 to 54.5). in subgroups characterized by high frequency of false-positive exercise electr ocardiographic tests (women and patients with a 10 year predicted risk of c oronary artery disease [CAD] <15%), none of the patients without carotid pl aque exhibited coronary lesions. Echographic evaluation of carotid plaque ( plaque vs no plaque) significantly improved the diagnostic specificity of e xercise electrocardiography. We conclude that the combination of clinical, electrical, and echographic data facilitates cost-effective noninvasive det ection of CAD in asymptomatic hypercholesterolemic patients, (C) 1999 by Ex cerpta Medica, Inc.