title: Additional value of inflammatory biomarkers and carotid artery disease in prediction of significant coronary artery disease as assessed by coronary computed tomography angiography.
abstract: OBJECTIVE
  To evaluate the relationship between an incremental model including cardiovascular risk factors, carotid disease, and inflammatory biomarkers to predict the presence of obstructive coronary artery disease (CAD).
  
  
  RESULTS
  A total of 134 consecutive and asymptomatic intermediate-risk patients (mean age 61 ± 9 years, 52% men) were enrolled. Each subject underwent circulating levels assessment of interleukin (IL)-2r, IL-6, IL-8, IL-10, high-sensitivity C-reactive protein (hs-CRP) and carotid and coronary artery evaluation using carotid ultrasound and coronary computed tomography angiography (CCTA), respectively. Carotid disease was diagnosed in 71 (53%) patients. Obstructive and multi-vessel CAD were found in 50 (37%) and 18 (14%) patients, respectively. Patients in whom CCTA showed multi-vessel CAD had a higher rate of carotid disease (89 vs. 46%, P = 0.001) and increased values of all interleukins when compared with patients without multi-vessel obstructive CAD. The univariate and multivariate analysis showed that male gender, diabetes, carotid disease, and IL-6 were independently associated with obstructive CAD. At receiver operating characteristic curve analysis, the multivariate model (including male gender, carotid disease, IL-6 > 5.9 pg/mL, and diabetes) showed the highest area under the curve for prediction of obstructive CAD, multi-vessel CAD, and high-risk plaque defined as mixed and/or remodelled plaque when compared with all other models (P < 0.001).
  
  
  CONCLUSIONS
  Among asymptomatic intermediate-risk patients, the presence of increased IL6 levels in addition to traditional risk factors (male gender with diabetes) and carotid artery disease predicts higher rates of obstructive CAD and it could be of help to identify which subset of asymptomatic patients could be referred to CCTA for screening.
authors.affiliation: Cardiology Unit, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy.|Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Andrea Igoren
authors.initials: AI
authors.lastname: Guaricci
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Fusini
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: De Luca
authors.affiliation: Department of Radiology, Scientific Institute 'Casa Sollievo della Sofferenza' Hospital, Foggia, Italy.
authors.forename: Francesco Pio
authors.initials: FP
authors.lastname: Cafarelli
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Guglielmo
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Baggiano
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Virginia
authors.initials: V
authors.lastname: Beltrama
authors.affiliation: Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Muscogiuri
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Saima
authors.initials: S
authors.lastname: Mushtaq
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Conte
authors.affiliation: Department of Radiology, Scientific Institute 'Casa Sollievo della Sofferenza' Hospital, Foggia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guglielmi
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.|Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.|Department of Biomedical and Clinical Sciences 'Luigi SACCO', University of Milan, Milan, Italy.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015897:Comorbidity; D000072226:Computed Tomography Angiography / Q000379:methods*; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D015994:Incidence; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment
chemical_list: D018836:Inflammation Mediators
keywords: carotid disease; computed tomography; coronary artery disease; cytokines; inflammatory biomarkers; risk stratification