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. 2018;14(1):52-58.
doi: 10.5114/aic.2018.74355. Epub 2018 Mar 22.

Intima-media thickness and ankle-brachial index are correlated with the extent of coronary artery disease measured by the SYNTAX score

Krzysztof L Bryniarski  1 , Tomasz Tokarek  2 , Tomasz Bryk  2 , Joanna Rutka  2 , Iwona Gawlik  3 , Anna Żabówka  2 , Grzegorz Dębski  2 , Beata Bobrowska  2 , Krzysztof Żmudka  1 , Artur Dziewierz  2 , Zbigniew Siudak  2 , Dariusz Dudek  2
Affiliations

Intima-media thickness and ankle-brachial index are correlated with the extent of coronary artery disease measured by the SYNTAX score

Krzysztof L Bryniarski et al. Postepy Kardiol Interwencyjnej. 2018.

Abstract

Introduction: The extent of peripheral artery disease (PAD) measured by the ankle-brachial index (ABI) and intima-media thickness (IMT) is correlated with the complexity of coronary artery disease (CAD) in stable angina patients. However, data regarding patients with acute coronary syndromes are still lacking.

Aim: To compare coronary complexity measured by the SYNTAX score in patients with and without PAD presenting with myocardial infarction (MI).

Material and methods: Both ABI and IMT were measured in 101 consecutive patients who underwent primary diagnostic due to MI. Patients were divided into three tertile groups depending on the SYNTAX score (0-4; 5-11; 12 and more points).

Results: Mean ABI in the general population was 0.9 ±0.26, mean IMT was 0.8 ±0.3 mm and mean SYNTAX score was 7.8 ±5.4 points. We found significant correlations between ABI and SYNTAX score (p = 0.01), IMT and SYNTAX score (p < 0.001), and IMT and ABI (p < 0.001). The highest mean values of IMT (p < 0.001) and lowest mean values of ABI (p = 0.015) were found in patients in the highest SYNTAX score group. When analyzing receiver operating characteristics (ROC) curves, IMT had greater specificity and sensitivity than ABI.

Conclusions: Both IMT and ABI are correlated with SYNTAX score (positively for IMT and negatively for ABI values). In our study, IMT was a better predictor of SYNTAX score than ABI. Our study suggests that the higher rate of cardiovascular events in patients with PAD presenting with MI may be partially explained by greater coronary lesion complexity.

Keywords: SYNTAX score; acute coronary syndrome; ankle-brachial index; carotid intima-media thickness; coronary artery disease; peripheral artery disease.

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Figures

Figure 1
Figure 1
Correlations between intima-media thickness (IMT), ankle-brachial index (ABI) and SYNTAX score
Figure 2
Figure 2
Ankle-brachial index (ABI) (A) and intima-media thickness (IMT) (B) for low (0–4 points), medium (5–11 points) and high SYNTAX score (12 points and more). Means for low SYNTAX score were 1 ±0.2 for ABI and 0.7 ±0.3 mm for IMT; for medium SYNTAX score were 0.9 ±0.3 for ABI and 0.9 ±0.2 mm for IMT; for high SYNTAX score were 0.7 ±0.2 for ABI and 1.1 ±0.1 mm for IMT. Markings on the graphs outside box plots represent outliers. Box shows range from first to third quartile. Whiskers show maximal and minimal non-outlier values. The vertical line in the box plot shows the median. All results were significant with p < 0.001 for IMT and p = 0.006 for ABI
Figure 3
Figure 3
Receiver operating characteristics (ROC) curves for ankle-brachial index (ABI) (A), intima-media thickness (IMT) (B) and SYNTAX score. A high-risk score was defined as a SYNTAX score of 12 points or more
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