title: Biomarkers of asymptomatic carotid stenosis in patients undergoing coronary artery bypass grafting.
abstract: OBJECTIVE
  Carotid artery stenosis is an important etiologic factor of stroke related to coronary artery bypass surgery. We evaluated clinical and laboratory factors to identify biomarkers for pre-existing carotid artery stenosis in patients undergoing coronary artery bypass surgery.
  
  
  METHODS
  Between June 2006 and September 2008, 811 patients aged ≥50 years underwent preoperative carotid artery duplex scanning as part of a preoperative assessment for nonemergency cardiac procedures. Of these, 54 patients with previous stroke or transient ischemic attack were excluded. The association between various biomarkers and carotid artery stenosis was analyzed by multiple logistic regression analysis. The receiver operating characteristic curves were generated and analyzed to compare diagnostic performance and optimum diagnostic cutoff levels of biomarkers.
  
  
  RESULTS
  A total of 757 patients was included in the study. The prevalence of asymptomatic carotid stenosis of ≥50% and ≥70% was 26.4% and 8.6%, respectively. In multivariate analysis, plasma levels of apolipoprotein B (apoB):apoA-I, lipoprotein(a), and homocysteine were independently associated with carotid stenosis of ≥50%: the OR (95% CI) for apoB/apoA-I, lipoprotein(a), and homocysteine in the highest versus lowest quartile was 2.07 (1.18 to 3.66), 2.17 (1.16 to 4.05), and 2.13 (1.20 to 3.79), respectively. Receiver operating characteristic curve analysis indicated area under the curve values of 0.708 (apoB:apoA-I), 0.678 (lipoprotein[a]), and 0.689 (homocysteine). The sensitivity, specificity, positive and negative predictive values (%) for diagnosis of carotid stenosis ≥50% were 80.0, 50.4, 38.0, and 86.9 for apoB:apoA-I; 47.0, 78.9, 46.1, and 79.5 for lipoprotein(a); and 69.3, 62.1, 41.2, and 84.1 for homocysteine, respectively.
  
  
  CONCLUSIONS
  Our findings indicated that plasma levels of apoB/apoA-I, lipoprotein(a), and homocysteine can predict asymptomatic carotid stenosis in patients undergoing coronary artery bypass surgery.
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
authors.forename: Suk Jae
authors.initials: SJ
authors.lastname: Kim
authors.forename: Pamela
authors.initials: P
authors.lastname: Song
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Park
authors.forename: Young Tak
authors.initials: YT
authors.lastname: Lee
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Kim
authors.forename: Yun Gyoung
authors.initials: YG
authors.lastname: Park
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Bang
authors.forename: Chin-Sang
authors.initials: CS
authors.lastname: Chung
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Lee
authors.forename: Gyeong-Moon
authors.initials: GM
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016632:Apolipoprotein A-I / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016893:Carotid Stenosis / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D015415:Biomarkers; D017270:Lipoprotein(a); D006710:Homocysteine