Correlation Between Ultrasound-Based Carotid Plaque Characteristics and Coronary Artery Disease Severity: A Retrospective Cross-Sectional Study

This study investigated the association between carotid ultrasound-derived plaque characteristics and the severity of coronary artery disease (CAD), and evaluated their incremental predictive value for identifying high coronary anatomical complexity. A total of 301 patients who underwent carotid ultrasound and coronary assessment (coronary angiography or coronary computed tomography angiography) within the same clinical period were included. CAD severity was assessed using the Gensini and SYNTAX scores. Carotid ultrasound parameters included intima-media thickness (IMT), plaque burden, plaque echogenicity, surface morphology, and carotid stenosis. Patients with higher SYNTAX scores demonstrated significantly increased IMT, greater plaque burden, and more high-risk plaque features. Spearman analysis showed that mean IMT exhibited the strongest correlation with both the Gensini score ( r = 0.65, P < .001) and the SYNTAX score ( r = 0.53, P < .001). In multivariable analyses, IMT remained independently associated with CAD severity. The addition of carotid ultrasound parameters improved model discrimination for identifying high SYNTAX scores, with the area under the receiver operating characteristic curve (AUC) increasing from 0.728 to 0.826. Carotid ultrasound parameters, particularly IMT, are associated with CAD severity and provide incremental value for identifying patients with complex coronary artery disease.