RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE 4 VOLUME 21 NUMBER 1 • November 2024 Correlation between carotid intima–media thickness and patient outcomes in coronary artery disease in central South Africa Abstract Objectives: Carotid intima–medial thickness (CIMT) is a noninvasive tool used to detect atherosclerosis and diagnose cardiovascular disease. This study aimed to determine whether pre-operative CIMT measurements correlated with intraand postoperative outcomes in patients with acute coronary syndrome (ACS) undergoing coronary artery bypass graft (CABG) surgery. Methods: This retrospective, analytical cohort included 89 patients diagnosed with ACS who received CABG surgery. Patients were divided into two cohorts: group 1: normal CIMT < 0.07 cm and group 2: abnormal CIMT ≥ 0.07 cm. B-mode ultrasound was used to measure the CIMT in all patients. Pre-, intra- and postoperative data and complications were recorded for each patient. Results: The study included 77 (86.5%) males and 12 (13.5%) females. Pre-operative mean body mass index was significantly higher (p = 0.03) in group 2 than in group 1. Group 2 had a significantly increased incidence of diabetes (p = 0.008) and hypertension (p = 0.009), and increased NT-proBNP levels (p = 0.02). Intra- and postoperative outcomes between the groups were comparable, with no significant differences. Conclusion: The study showed no correlation between abnormal CIMT and increased adverse intra- and postoperative patient outcomes. Therefore, the results of this study show CIMT should not be considered a tool to predict adverse events in patients undergoing CABG surgery. Keywords: carotid intima–media thickness, acute coronary syndrome, outcomes, complications, coronary artery bypass graft surgery Global cardiovascular deaths are estimated at 17.9 million annually, representing 31% of all deaths.1 In sub-Saharan Africa (SSA), noncommunicable diseases are the second most common cause of death, accounting for 2.6 million deaths or 35%.2 From the year 2000 to 2016, SSA experienced a 37% increase in coronary heart disease, with a projected increase of 21% by 2030.3 The early detection of high-risk individuals has significant clinical value. Measurement of carotid intima–medial thickness (CIMT) has been used as a marker to establish the presence,4 risk5 and extent6 of cardiovascular disease (CVD). Several studies have validated the application of this imaging technique because it can detect slight changes over time, associated with future cardiovascular events.7,8 The 2010 American Heart Association/American College of Cardiology guidelines recommended measurement of CIMT as a class IIa (reasonable to perform) recommendation for cardiovascular risk assessment in asymptomatic adults with intermediate cardiovascular risk.9 The Mannheim Carotid Intima–Media Thickness and Plaque Consensus update from the advisory board of the Watching the Risk symposium in 2004 stated that CIMT and the measurement of plaque presence are recommended for the initial detection of CVD risk in asymptomatic patients at intermediate risk or if risk factors were present. Several authors10,11 have investigated the correlation between CIMT and an increased risk for the development of coronary artery disease (CAD) and concluded that, with an increase in CIMT, the risk of CAD and myocardial infarction becomes correspondingly higher. Cardiac surgery with cardiopulmonary bypass (CPB) causes the systemic inflammatory response syndrome (SIRS), of which two to 6% of cases are associated with severe morbidity and death.12 Lactate production is a well-established indicator of tissue perfusion and regional brain oxygen saturation13 during CPB.14 Atherosclerosis adversely affects the endothelium and is associated with an abnormal inflammatory response.15-17 Since the mechanism of SIRS is linked to the endothelial response during CPB circulation, changes in endothelial function and tissue oxygenation are negatively affected by SIRS.18 CIMT is a valuable marker to predict the severity of coronary artery atherosclerosis; it may be postulated that CIMT can be used to predict surgical outcomes. Limited data are available on CIMT and its correlation with operative outcomes in coronary artery bypass graft (CABG) patients,19,20 with no data being available for the central South African population. The aim of this study was to investigate whether pre-operative CIMT measurements in acute coronary syndrome (ACS) patients undergoing elective CABG surgery would affect intra- and postoperative surgical outcomes. V Mokoena, L Botes, SC Brown, FE Smit Correspondence to: SC Brown Department of Paediatric Cardiology, University of the Free State, Bloemfontein, South Africa e-mail: Gnpdscb@ufs.ac.za V Mokoena, FE Smit Department of Cardiothoracic Surgery, University of the Free State, Bloemfontein, South Africa L Botes Department of Health Sciences, Central University of Technology, Bloemfontein, South Africa Previously published online in Cardiovasc J Afr November 2023 S Afr J Diabetes Vasc Dis 2024; 21: 4–9
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