Computed tomography characteristics of coronary artery atherosclerosis in subjects with lower extremity peripheral artery disease and no cardiac symptoms

INTRODUCTION Computed tomography coronary angiography (CTCA) enables noninvasive evaluation of coronary artery atherosclerosis. However, its value to assess coronary artery disease (CAD) in subjects with lower‑extremity peripheral artery disease (PAD) and no cardiac symptoms is unknown. Moreover, the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in this group of patients was not sufficiently elucidated.
OBJECTIVES The aim of the study was to determine the value of CTCA to assess coronary artery atherosclerosis and to evaluate the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in subjects with lower‑extremity PAD and no cardiac symptoms.
PATIENTS AND METHODS Sixty‑five individuals (45 men, 20 women, mean age, 62.5 ±7.6 years) with lower‑extremity PAD and no cardiac symptoms underwent CTCA.
RESULTS CTCA revealed CAD in 56 subjects. Twenty‑two had obstructive CAD. The mean ankle–brachial index (ABI) was 0.64 ±0.16. Twenty‑six individuals demonstrated abnormal carotid artery intima–media thickness (IMT). ABI lower than median, if compared with ABI equal of higher than median, was associated with a higher proportion of obstructive multivessel to single vessel CAD (8:4 vs. 1:9; P = 0.01) and higher number of coronary artery segments with mixed plaques (2.3 ±2.2 vs. 1.2 ±1.3; P = 0.02). Comparing patients with abnormal and normal IMT, the former demonstrated higher proportion of obstructive multivessel to single-vessel CAD (7:3 vs. 2:10; P = 0.01) and higher number of coronary artery segments with noncalcified (1.9 ±3.2 vs. 0.6 ±1.4; P = 0.04) and mixed plaques (2.3 ±2.1 vs. 1.3 ±1.7; P = 0.049).
CONCLUSIONS CTCA may be effective to detect CAD in subjects with lower‑extremity PAD and no cardiac symptoms. The low ABI and abnormal IMT are associated with more extensive CAD and higher burden of high‑risk coronary artery plaques.