Can a referral diagnosis code for duplex ultrasound "predict" carotid artery stenosis?

Aim. To evaluate the detection rate of carotid artery stenosis (CAS) based on the diagnosis code according to the International Clas­sification of Diseases of 10th revision (ICD-10), used in appointment card for carotid duplex ultrasound.

Material and methods. To conduct this study, the Duplex-2013 registry database was used, which sequentially included 2548 patients. When referring to carotid duplex ultrasound, all patients indicated the ICD-10 diagnosis code as the main reason for seeking medical help. The study assessed the presence and severity of CAS, the probability of CAS, taking into account age, sex, and referral diagnosis according to ICD-10.

Results. According to the results of a univariate analysis, the following referral diagnoses were associated with the identification of CAS by two criteria (stenosis ≥20 and ≥50%): generalized/peripheral atherosclerosis (GPA) — odds ratio (OR), 6,54; 95% confidence interval (CI): 2,71-18,89 (p<0,001) and OR, 11,91; 95% CI: 6,17-22,75 (p<0,001), postinfarction cardiosclerosis — OR, 5,63; 95% CI: 2,62-13,6 (p<0,001) and OR, 3,08; 95% CI: 1,39-6,28 (p=0,004), CAS — OR, 3,26; 95% CI: 2,08-5,27 (p<0,001) and OR, 2,29; 95% CI: 1,25-3,96 (p=0,006) and hypertension, OR, 2,2; 95% CI: 1,87-2,58 (p<0,0001) and OR, 1,45; 95% CI: 1,07-1,97 (p=0,02). Taking into account age and sex, the probability of CAS detection (>20%) is associated with HTN — OR, 1,43; 95% CI: 1,19-1,71 (p<0,001), postinfarction cardiosclerosis — OR, 2,89; 95% CI: 1,20-6,94 (p=0,01) and GPA — OR, 4,52; 95% CI: 1,65-12,35 (p=0,003); CAS >50% — acute myocardial infarction — OR, 8,45; 95% CI: 1,32-53,97 (p=0,02) and GPA — OR, 9,82; 95% CI: 4,81-20,04 (p<0,001).

Conclusion. Certain groups of referral diagnoses (ICD-10 codes) are associated with a higher probability of CAS. The obtained data needs to be refined in order to optimize routing and referral for carotid duplex ultrasound.

1. Murray C, Nahar T, Kalashyan H, et al. Ultrasound assessment of carotid arteries: Current concepts, methodologies, diagnostic criteria, and technological advancements. Echocardiography. 2018;35(12):2079-91. doi:10.1111/echo.14197.

2. Hirunagi T, Miwa S, Katsuno M. Nonstenotic Carotid Plaque in Patients with Anterior Circulation Embolic Stroke of Undeter­mined Source. Brain Nerve. 2018;70(11):1295-9. doi:10.11477/mf.1416201176.

3. Gao P, Chen Z, Jiao L, et al. The correlation of carotid plaque pathohistologic features and neurological symptoms: a meta-analysis of observational studies. Neurol India. 2007;55(2):122-9. doi:10.4103/0028-3886.3278.

4. Pfister K, Janotta M, Apfelbeck H, et al. How dangerous is a carotid plaque? Vasa. 2013;42(3):155-7. doi:10.1024/0301-1526/a000262.

5. Visseren F, Mach F, Smulders Y, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-337. doi:10.1093/eurheartj/ehab484.

6. Kakorina E, Aleksandrova G, Frank G, et al. Procedure for coding the causes of death in some circulatory system diseases. Arkhiv Patologii. 2014;76(4):45-52. (In Russ.)

7. Mazzali C, Paganoni A, Ieva F, et al. Methodological issues on the use of administrative data in healthcare research: the case of heart failure hospitalizations in Lombardy region, 2000 to 2012. BMC Health Serv Res. 2016;16:234. doi:10.1186/s12913-016-1489-0.

8. Martsevich SYu, Kutishenko NP, Lukina YuV, et al. Observational studies and registers. Their quality and role in modern evidence-based medicine. Cardiovascular Therapy and Prevention. 2021;20(2):2786. (In Russ.) doi:10.15829/1728-8800-2021-2786.

9. Kolomiychenko ME, Vaysman DS. On the issue of morbidity and mortality encoding. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2020;28(4):535-40. (In Russ.) doi:10.32687/0869-866X-2020-28-4-535-540.

10. Ung D, Kim J, Thrift A, et al. Promising Use of Big Data to Increase the Efficiency and Comprehensiveness of Stroke Outcomes Research. Stroke. 2019;50(5):1302-9. doi:10.1161/STROKEAHA.118.020372.

11. Gaisenok OV, Kurnosov PA, Leonov AS, Zateyshchikov DA. Screening of familial hypercholesterolemia among patients in age under 40 years old exposed by duplex scanning of carotid arteries, by the local registry data. Terapevticheskii arkhiv. 2018;90(9):37-41. (In Russ.) doi:10.26442/terarkh201890937-41.

12. Gaisenok OV, Rezvaya AA. A comparative analysis of the clinical and anamnestic status of patients with chronic occlusion of the carotid arteries based on the data of obser­vatio­nal regis­tries. Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova. 2022;122(12-2):33-41. (In Russ.) doi:10.17116/jnevro202212212233.

13. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28(12):1462-536. doi:10.1093/eurheartj/ehm236.

14. European Carotid Surgery Trialists’ Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351:1379-87. doi:10.1016/S0140-6736(97)09292-1.

15. At’kov OYu, Balakhonova TV, Gorohova SG. Ultrasound examination of the heart and blood vessels / ed. O. Yu. At’kov. M.: Eksmo, 2009. 400 p. (In Russ.)

16. Kaveshnikov VS, Trubacheva IA, Serebryakova VN. Factors associated with carotid plaque burden in the adult general population. Russian Journal of Cardiology. 2021;26(5):4379. (In Russ.) doi:10.15829/1560-4071-2021-4379.

17. Laclaustra M, Casasnovas J, Fernández-Ortiz A, et al. Femoral and Carotid Subclinical Atherosclerosis Association with Risk Factors and Coronary Calcium: The AWHS Study. J Am Coll Cardiol. 2016;67(11):1263-74. doi:10.1016/j.jacc.2015.12.056.

18. López-Melgar B, Fernández-Friera L, Oliva B, et al. Subclinical Atherosclerosis Burden by 3D Ultrasound in Mid-Life: The PESA Study. J Am Coll Cardiol. 2017;70(3):301-13. doi:10.1016/j.jacc.2017.05.033.

19. LeBlanc S, Bibeau K, Bertrand O, et al. Carotid versus coronary atherosclerosis burdens in acute compared with chronic symptomatic coronary artery disease. Can J Physiol Pharmacol. 2017;95(8):878-87. doi:10.1139/cjpp-2016-0588.

20. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020;25(11):4103. (In Russ.) doi:10.15829/1560-4071-2020-4103.

21. Barbarash OL, Duplyakov DV, Zateischikov DA, et al. 2020 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation. Russian Journal of Cardiology 2021;26(4):4449. (In Russ.) doi:10.15829/1560-4071-2021-4449.

22. Krist A, Davidson K, Mangione C, et al. Screening for Asympto­matic Carotid Artery Stenosis: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(5):476-81. doi:10.1001/jama.2020.26988.

23. Balakhonova TV, Ershova AI, Ezhov MV, et al. Focused vascu­lar ultrasound. Consensus of Russian experts. Cardio­vascular Therapy and Prevention. 2022;21(7):3333. (In Russ.) doi:10.15829/1728-8800-2022-3333.

24. Kukharchuk VV, Ezhov MV, Sergienko IV, et al. Diagnosis and correction of lipid metabolism disorders in order to prevent and treat atherosclerosis. Russian recommendations, VII revision. The Journal of Atherosclerosis and Dyslipidemias. 2020;1(38):7-42. (In Russ.) doi:10.34687/2219-8202.JAD.2020.01.0002.

25. Sammani A, Bagheri A, van der Heijden P, et al. Automatic multi­label detection of ICD10 codes in Dutch cardiology discharge letters using neural networks. NPJ Digit Med. 2021;4(1):37. doi:10.1038/s41746-021-00404-9.