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Background: Carotid intima-media thickness (CIMT) is considered a marker of atherosclerosis, but the data is lacking from the South Asian population. We aimed to study the relation of CIMT with the presence and severity of coronary artery disease (CAD) in this population. Methods: This was a prospective, single-center study of consecutive patients undergoing elective coronary angiography. Participants with >50% luminal stenosis in any major coronary artery were included in the CAD group and those with normal coronaries in the non-CAD group. Multivariate linear regression analysis was done to determine independent predictors of CAD. Pearson's correlation coefficients assessed correlations between CIMT and Syntax and Gensini score. Results: The mean CIMT was significantly much higher in the CAD group when compared to the non-CAD group (0.83±0.16 vs 0.61±0.14mm, p<0.001). On multivariable linear regression analysis only diabetes (β=0.208 and p=0.024), waist–hip ratio (β=0.178 and p=0.043), current smoker (β=0.293 and p=<0.001) and CIMT (β=0.217 and p=0.031) were independent predictors of CAD. The mean Gensini score in the CAD group was 48.59±34.25 and the mean Syntax score was 19.45±10.24. No significant relation was found between CIMT and Gensini score (r=0.009 and p=0.89), and Syntax score (r=−0.087 and p=0.171). Conclusion: Mean CIMT is an independent predictor of CAD along with diabetes, waist–hip ratio, and smoking. However, CIMT was not related to the severity and complexity of the CAD as assessed by the Gensini score and Syntax score, respectively. (AU)

Antecedentes: El grosor de íntima media carotídeo (GIM) está considerado un marcador de la aterosclerosis, aunque se carece de datos relativos a la población del sur de Asia. Nuestro objetivo fue estudiar la relación de GIM con la presencia y gravedad de la enfermedad de las arterias coronarias (EAC) en esta población. Métodos: Estudio prospectivo y unicéntrico de pacientes consecutivos sometidos a angiografía coronaria electiva. Se incluyó en el grupo EAC a los participantes con >50% estenosis luminal en cualquier arteria coronaria mayor, y en el grupo no EAC a los participantes con arterias coronarias normales. Se realizó un análisis de regresión lineal multivariante para determinar los factores predictivos independientes de EAC. Los coeficientes de correlación de Pearson evaluaron las correlaciones entre GIM y las puntuaciones de Gensini y Syntax. Resultados: El GIM medio fue significativamente mayor en el grupo EAC en comparación con el grupo no EAC (0,83±0,16 vs. 0,61±0,14mm, p<0,001). En el análisis de regresión lineal multivariante solo la diabetes (β=0,208 y p=0,024), el índice cintura-cadera (β=0,178 y p=0,043), y el tabaquismo actual (β=0,293 y p=<0,001) y GIM (β=0,217 y p=0,031) fueron factores predictivos independientes de EAC. La puntuación Gensini media en el grupo EAC fue de 48,59±34,25, y la puntuación Syntax media fue de 19,45±10,24. No se encontró relación significativa entre GIM y la puntuación de Gensini (r=0,009 y p=0,89) y la puntuación Syntax (r=−0,087 y p=0,171). Conclusión: El GIM medio es un factor predictivo independiente de EAC, junto con la diabetes, el índice cintura-cadera y el tabaquismo. Sin embargo, GIM no guardó relación con la gravedad y complejidad de EAC, según la evaluación de las puntuaciones de Gensini y Syntax, respectivamente. (AU)

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BACKGROUND: Carotid intima-media thickness (CIMT) is considered a marker of atherosclerosis, but the data is lacking from the South Asian population. We aimed to study the relation of CIMT with the presence and severity of coronary artery disease (CAD) in this population. METHODS: This was a prospective, single-center study of consecutive patients undergoing elective coronary angiography. Participants with >50% luminal stenosis in any major coronary artery were included in the CAD group and those with normal coronaries in the non-CAD group. Multivariate linear regression analysis was done to determine independent predictors of CAD. Pearson's correlation coefficients assessed correlations between CIMT and Syntax and Gensini score. RESULTS: The mean CIMT was significantly much higher in the CAD group when compared to the non-CAD group (0.83±0.16 vs 0.61±0.14mm, p<0.001). On multivariable linear regression analysis only diabetes (ß=0.208 and p=0.024), waist-hip ratio (ß=0.178 and p=0.043), current smoker (ß=0.293 and p=<0.001) and CIMT (ß=0.217 and p=0.031) were independent predictors of CAD. The mean Gensini score in the CAD group was 48.59±34.25 and the mean Syntax score was 19.45±10.24. No significant relation was found between CIMT and Gensini score (r=0.009 and p=0.89), and Syntax score (r=-0.087 and p=0.171). CONCLUSION: Mean CIMT is an independent predictor of CAD along with diabetes, waist-hip ratio, and smoking. However, CIMT was not related to the severity and complexity of the CAD as assessed by the Gensini score and Syntax score, respectively.

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INTRODUCTION AND OBJECTIVES: The predictive value of the SYNTAX score (SS) for clinical outcomes after transcatheter aortic valve implantation (TAVI) is very limited and could potentially be improved by the combination of anatomic and clinical variables, the SS-II. We aimed to evaluate the value of the SS-II in predicting outcomes in patients undergoing TAVI. METHODS: A total of 402 patients with severe symptomatic aortic stenosis undergoing transfemoral TAVI were included. Preprocedural TAVI angiograms were reviewed and the SS-I and SS-II were calculated using the SS algorithms. Patients were stratified in 3 groups according to SS-II tertiles. The coprimary endpoints were all-cause death and major adverse cardiovascular events (MACE), a composite of all-cause death, cerebrovascular event, or myocardial infarction at 1 year. RESULTS: Increased SS-II was associated with higher 30-day mortality (P=.036) and major bleeding (P=.015). The 1-year risk of death and MACE was higher among patients in the 3rd SS-II tertile (HR, 2.60; P=.002 and HR, 2.66; P<.001) and was similar among patients in the 2nd tertile (HR, 1.27; P=.507 and HR, 1.05; P=.895) compared with patients in the 1st tertile. The highest SS-II tertile was an independent predictor of long-term mortality (P=.046) and MACE (P=.001). CONCLUSIONS: The SS-II seems more suited to predict clinical outcomes in patients undergoing TAVI than the SS-I. Increased SS-II was associated with poorer clinical outcomes at 1 and 4 years post-TAVI, independently of the presence of coronary artery disease.

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INTRODUCTION AND OBJECTIVES: Previous studies have reported that coronary intervention for complex lesions is independently correlated with major bleeding. The SYNTAX score is an angiographic tool used to grade the complexity of coronary artery diseases. The aim of this study was to assess the ability of the SYNTAX score to predict major bleeding following drug-eluting stent implantation. METHODS: We analyzed 722 patients who underwent drug-eluting stent implantation in an all-comers population between January 2007 and April 2010. The incidence of major bleeding and stent thrombosis was investigated during a 2-year period. Major bleeding was evaluated using the CRUSADE score and Bleeding Academic Research Consortium criteria. Patients were stratified into the following groups according to the SYNTAX trial: low (≤ 22; n=484), intermediate (23-32; n=128), and high (≥ 33; n=110). RESULTS: Major bleeding was observed in 47 patients (6.5%) during the 2-year period, and there were 12 incidents of stent thrombosis (1.7%). Major bleeding rates for patients in the low, intermediate, and high SYNTAX score tertiles were 2.9%, 7.8%, and 20.9%, respectively (P < .0001). The SYNTAX score had an adjusted hazard ratio of 1.81 (95% confidence interval, 1.27-2.57) for 2-year major bleeding. The predictive value of the adjusted area under the receiver operating characteristic curve for major bleeding significantly improved after inclusion of the CRUSADE score (C statistic, 0.890 vs 0.812). CONCLUSIONS: Although the SYNTAX score can predict major bleeding risk, the predictive value of the CRUSADE score was higher. These scores may be useful in clinical decision-making on revascularization strategies and on the optimal duration of dual antiplatelet therapy following drug-eluting stent implantation.

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