Early Diagnosis and Treatment of Coronary Heart Disease in Symptomatic and Asymptomatic Subjects with Advanced Vascular Atherosclerosis of the Carotid Artery

Within the scope of an occupational screening program people were given the opportunity to determine their risk of heart attack. During the study the total plaque area (TPA), the maximum plaque thickness in the carotid artery and the PROCAM-Scores of 5928 healthy subjects were determined.

In the follow up 8 strokes and 55 CHD have occurred. 50 subjects exhibited a type III or IV b finding in the baseline ultrasound examination.

The testing method was validated by means of a blinded examination of 500 patients in hospital 1 day prior to a scheduled coronary angiogram. This allowed the classification of the ultrasound findings into 4 types. 87% of the patients suffering from a stenosing coronary heart condition were accurately predicted.

Subsequently, 442 healthy subjects with a type III or type IV b finding were contacted and specifically asked if they were experiencing symptoms such as exertional dyspnea or angina pectoris. 37 subjects complained of exertional dyspnea or of atypical angina pectoris or typical angina pectoris. Nine subjects had no symptoms at all. Further cardiac assessment was recommended. A comparison was drawn between the results of the ultrasound examination and the exercise ECG.

In the case of 22 patients the PROCAM-Score was < 10%, 14 patients had a score of 10-20% and 10 patients a score of > 20%. In the final analysis only 5 patients had entirely smooth coronary arteries, 7 had coronary sclerosis and 34had stenosis 30-100%. The exercise ECG only achieved a true positive result in the case of 4 patients, and in the case of 21 patients the result was false negative.

Subjects with symptoms such as exertional dyspnea, atypical or typical angina pectoris, and advanced atherosclerosis of the carotid artery (type III or type IV b finding) have a high risk of CHD. Cardiac assessment using an exercise ECG is insufficient since the sensitivity level of this test is too low. An early diagnosis of CHD using ischemia imaging proves unsuccessful since no ischemia is present. The PROCAM-Score also does not close this diagnostic gap since it does not accurately display the risks associated with atherosclerosis.