Coronary artery disease (CAD) remains one of the leading causes of morbidity and mortality worldwide and has emerged as a major public health concern in developing countries like India ¹. The rising incidence and earlier onset of CAD in the Indian population highlight the need for early detection and prevention strategies. Atherosclerosis, the underlying pathology, is a systemic vascular disease affecting both coronary and carotid arteries². Early identification of subclinical atherosclerosis is crucial for reducing cardiovascular events and improving clinical outcomes ³.

Traditionally, cardiovascular risk assessment has relied on clinical risk factors and scoring systems such as the Framingham Risk Score ⁴. However, these conventional methods may underestimate the true burden of atherosclerosis. Although coronary angiography is considered the gold standard for diagnosing CAD, its invasive nature, high cost, and limited availability restrict its widespread use ^5-6. In this context, carotid intima–media thickness (CIMT), measured by high-resolution B-mode ultrasonography, has emerged as a simple, non-invasive, and cost-effective surrogate marker of systemic atherosclerosis ^7-8.

Several studies have demonstrated a significant correlation between increased CIMT and the presence and severity of coronary artery disease ^9-10. However, variability in findings, especially in the Indian population, necessitates further evaluation ^11-12. Therefore, the present study was conducted to assess CIMT in patients with acute coronary syndrome (ACS) and to evaluate its correlation with coronary artery disease using coronary angiography.

Aims and Objectives: To evaluate carotid intima-media thickness (CIMT) in patients presenting with acute coronary syndrome, To assess the correlation between CIMT and the presence and severity of coronary artery disease as determined by coronary angiography. To determine the role of CIMT as a non-invasive surrogate marker for predicting coronary atherosclerotic burden in ACS patients

Study Design: Cross-sectional observational study. Study Centre: Department of Medicine, Sanjay Gandhi Memorial Hospital, associated with Shyam Shah Medical College and Superspeciality Block, Rewa, Madhya Pradesh. Study Duration: One year. Sample Size: A total of 80 patients were included, calculated using the formula n = 4pq/l² based on an estimated prevalence of 11% of ACS in non-diabetic patients. Ethical Consideration: The study was conducted after approval from the Institutional Ethics Committee. Written informed consent was obtained from all participants, and confidentiality of patient data was maintained. Inclusion Criteria: • Patients aged >18 years with confirmed acute coronary syndrome (STEMI, NSTEMI, unstable angina) • Non-diabetic patients • Patients undergoing coronary angiography • Patients providing informed consent • Feasible CIMT measurement by ultrasonography Exclusion Criteria: • Known diabetes mellitus • History of MI, PCI, or CABG • Valvular/congenital heart disease • Chronic inflammatory disease or malignancy • Long-term statin therapy (>6 months) • Poor quality CIMT imaging • Hemodynamically unstable or non-consenting patients Procedure Plan: Eligible ACS patients were evaluated clinically, followed by laboratory investigations, CIMT measurement using B-mode ultrasonography, and coronary angiography during the same admission. Methods of Data Collection: Data were collected using a predesigned proforma including demographic details, clinical history, risk factors, CIMT values, and angiographic findings. Investigations: • Hematological and biochemical tests (CBC, RBS, RFT, LFT, electrolytes) • 12-lead ECG • CIMT measurement (≥7.5 MHz probe, bilateral mean value) • Coronary angiography (LAD, LCX, RCA, LM assessment; Gensini/SYNTAX scoring) Outcome Measures: • Primary Outcome: Correlation between CIMT and severity of CAD • Secondary Outcome: Association of CIMT with risk factors and prediction of significant CAD (>50% stenosis) Statistical Analysis: Data were analyzed using statistical software (SPSS). Tests included t-test, correlation, and regression analysis. A p-value <0.05 was considered statistically significant.

Table 1: Demographic Characteristics

Table 2: Clinical Risk Factors

Table 3: Mean Carotid IMT vs Clinical Variables

Table 4: Inter-arm SBP Difference Analysis

Table 5: Metabolic Profile (Dyslipidemia & BMI)

The present study provides a comprehensive overview of demographic characteristics, risk factors, and their association with carotid intima–media thickness (CIMT) in patients with acute coronary syndrome. The demographic profile (Table 1) reveals that the study population was predominantly elderly, with more than half of the participants above 60 years of age and a mean age of 61.76 ± 13.24 years. There was a clear male predominance (63.75%) and a higher proportion of urban residents (76.25%), suggesting a greater burden of cardiovascular disease in older, male, and urban populations.

The analysis of clinical risk factors (Table 2) shows that hypertension (52.5%) and coronary artery disease (51.25%) were the most prevalent, followed by smoking (31.25%) and stroke (20%). These findings highlight the high burden of cardiovascular comorbidities in the study group.

Table 3 demonstrates that CIMT was significantly higher in patients with hypertension (0.92 ± 0.11 mm) and CAD (0.87 ± 0.10 mm) compared to those without these conditions (p<0.001 and p<0.0001, respectively), indicating a strong association with atherosclerosis. However, smoking and stroke did not show statistically significant associations with CIMT.

Inter-arm systolic blood pressure (SBP) analysis (Table 4) showed that 18.75% of patients had a difference >10 mmHg. Although its association with hypertension was not significant (p=0.521), patients with higher inter-arm SBP differences had significantly increased CIMT (0.95 ± 0.12 mm; p<0.001), suggesting its role as a marker of subclinical vascular disease.

Metabolic factors (Table 5) revealed that dyslipidemia (40%) and higher BMI were significantly associated with increased CIMT. A progressive rise in CIMT was observed from normal to obese categories, indicating the impact of metabolic abnormalities on atherosclerosis.

The our cross-sectional study was conducted to evaluate carotid intima–media thickness (CIMT) in patients with acute coronary syndrome (ACS) and to determine its correlation with coronary artery disease (CAD). The findings of our study strongly support the concept that atherosclerosis is a systemic process, and CIMT serves as a reliable non¬invasive surrogate marker of coronary atherosclerosis. In our study, the mean age was 61.76 ± 13.24 years, with 56.25% of patients above 60 years, indicating a predominance of elderly individuals. This finding is consistent with Sekar A et al (2024)13, who reported a mean age of 60.8 ± 11.5 years, with the majority above 60 years. Similarly, Muthanna BA et al (2023)14 observed a mean age of 59.4 ± 10.2 years, while Weng Z et al (2023)15 reported 62.1 ± 9.8 years. Studies by Satpathy C et al (2025)16 and Allam RN et al (2025)17 also demonstrated that more than half of patients were above 60 years. These findings emphasize that advancing age is a major determinant of atherosclerosis and CIMT progression. The our study showed a male predominance (63.75%), which is comparable to Sekar A et al (2024)13 (66% males), Muthanna BA et al (2023)14 (64%), and Weng Z et al (2023)15 (68%). Similar observations were reported by Satpathy C et al (2025)16 and Allam RN et al (2025)17. This gender disparity may be attributed to higher exposure to risk factors such as smoking, occupational stress, and lifestyle differences in males. Urban predominance (76.25%) observed in our study reflects changing lifestyle patterns and increased cardiovascular risk in urban populations. This is supported by recent literature indicating higher CAD prevalence in urban settings due to sedentary habits and dietary factors. Hypertension (52.5%) and CAD (51.25%) were the most common risk factors in our study. Similar findings were reported by Wani AS et al (2018)18, who demonstrated that hypertension significantly influences CIMT. Sekar A et al (2024)13 also reported a strong association between hypertension and CAD. These findings highlight the critical role of hypertension in accelerating vascular remodeling and atherosclerosis. A significant association between CIMT and hypertension was observed in our study (0.92 ± 0.11 mm vs 0.76 ± 0.09 mm; p<0.001). This is in agreement with Wani AS et al (2018)18, who found hypertension to be a major determinant of increased CIMT. Similarly, Sekar A et al (2024)13 demonstrated significantly elevated CIMT in hypertensive patients, supporting our findings. Smoking, although associated with slightly higher CIMT in our study, did not show statistical significance (p=0.107). This finding is partially supported by Wani AS et al (2018)18, where smoking showed a positive but variable association with CIMT. This variability may be due to differences in smoking duration, intensity, and sample size. A strong association between CIMT and CAD was observed in our study (0.87 ± 0.10 mm vs 0.77 ± 0.07 mm; p<0.0001). This finding is consistent with Coskun U et al (2009)19, who reported significantly higher CIMT in CAD patients (1.48 ± 0.28 mm) compared to non-CAD individuals (0.78 ± 0.21 mm). Similarly, Mahabub SM et al (2013)20 demonstrated a positive correlation between CIMT and severity of CAD using vessel and stenosis scores. Recent evidence by Sireesha K et al (2023)21 also showed a significant correlation between CIMT and SYNTAX score, reinforcing CIMT as a marker of CAD severity. In our study, stroke did not show a significant association with CIMT (p=0.734). This may be due to the smaller number of stroke patients or overlapping risk factors influencing CIMT independently. Inter-arm systolic blood pressure (SBP) difference >10 mmHg was observed in 18.75% of patients. Although its association with hypertension was not significant, CIMT was significantly higher in these patients (0.95 ± 0.12 mm; p<0.001). This supports the concept that inter-arm SBP difference reflects underlying vascular asymmetry and atherosclerosis. Dyslipidemia was present in 40% of patients and showed a strong association with CIMT (0.91 ± 0.11 mm vs 0.79 ± 0.10 mm; p<0.001). This is consistent with Wani AS et al (2018)18, who identified lipid abnormalities as significant contributors to CIMT progression. BMI analysis in our study revealed that overweight (53.75%) and obese individuals had significantly higher CIMT values. This finding is supported by Wani AS et al (2018)18, who demonstrated a positive relationship between BMI and CIMT. Increasing adiposity contributes to endothelial dysfunction and systemic inflammation, promoting atherosclerosis. The majority of patients in our study were on statins (78.75%) and antiplatelets (73.75%), reflecting adherence to standard treatment guidelines. This aligns with current recommendations emphasizing aggressive risk factor modification.

The our study demonstrates that carotid intima–media thickness (CIMT) is significantly associated with major cardiovascular risk factors and the presence of coronary artery disease in patients with acute coronary syndrome. Higher CIMT values were observed in patients with hypertension, dyslipidemia, increased BMI, and significant inter-arm systolic blood pressure differences, indicating its strong relationship with subclinical atherosclerosis. A significant correlation between CIMT and CAD further supports its role as a surrogate marker of coronary atherosclerotic burden. The predominance of elderly, male, and urban patients highlights the influence of demographic and lifestyle factors. Overall, CIMT emerges as a simple, non-invasive, and cost-effective tool for early detection, risk stratification, and guiding management of cardiovascular disease, especially in resource-limited settings.

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