title: The value of noncoronary atherosclerosis for identifying coronary artery disease: results of the Leipzig LIFE Heart Study.
abstract: BACKGROUND
  Despite the widespread use of noninvasive testing prior to invasive coronary diagnostic the diagnostic yield of elective coronary angiography has been reported low in subjects with suspected obstructive CAD.
  
  
  OBJECTIVE
  To determine the predictive value of noncoronary atherosclerosis (NCA) in subjects with suspected stable coronary artery disease (CAD) intended to invasive coronary angiography.
  
  
  METHODS
  Ultrasound-based assessment of carotid artery plaque (CAP), carotid intima-media thickness (CIMT) and ankle-brachial index (ABI) was performed in 2216 subjects with suspected CAD prior to coronary angiography. Logistic regression and c-statistics were used to analyze the diagnostic value of NCA for the presence of obstructive CAD and the intention to revascularization.
  
  
  RESULTS
  Percentage of positive results of elective coronary angiography was low but comparable to other studies (41% obstructive CAD). We identified 1323 subjects (60%) with NCA, most of them were characterized by CAP (93%). CAP independently predicted obstructive CAD in addition to traditional risk factors and clinical factors while CIMT and ABI failed to improve the prediction. The presence of NCA and typical angina were the strongest predictors for obstructive CAD (OR 4.0 and 2.4, respectively). A large subgroup of patients (n = 703, 32%) with atypical clinical presentation and lack of NCA revealed a low indication for revascularization <15% indicating a large proportion of subjects with non-obstructive CAD in this subgroup.
  
  
  CONCLUSIONS
  The evaluation of noncoronary atherosclerosis has the potential to impact clinical decision making and to direct subsequent diagnostic procedures in subjects with suspected coronary artery disease.
  
  
  BACKGROUND
  NCT00497887.
authors.affiliation: Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.|LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Weissgerber
authors.affiliation: LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.|Institute of Medical Informatics, Statistic and Epidemiology, University Leipzig, Leipzig, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Scholz
authors.affiliation: Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.|LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.
authors.forename: Andrej
authors.initials: A
authors.lastname: Teren
authors.affiliation: Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Sandri
authors.affiliation: LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.|Institute of Laboratory Medicine, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Teupser
authors.affiliation: LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.|Department of Medicine III, University Hospital Halle (Saale), Halle/Saale, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Gielen
authors.affiliation: LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.|Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Thiery
authors.affiliation: Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.|LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. beutner.le@googlemail.com.|LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany. beutner.le@googlemail.com.
authors.forename: Frank
authors.initials: F
authors.lastname: Beutner
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index / Q000379:methods; D050197:Atherosclerosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors
keywords: Ankle-brachial index; Coronary artery disease; Intima-media thickness; Noncoronary atherosclerosis, carotid artery plaque