Objective To evaluate the predictive value of the carotid plaque reporting and data system (Plaque-RADS) and ultrasound features for the severity of coronary artery stenosis.

Methods This was a single-center prospective observational study. A total of 271 consecutive patients with suspected coronary artery disease or at high cardiovascular risk, hospitalized in the Department of Cardiology of Zhongshan Hospital, Fudan University from July 2023 to June 2024, were enrolled. Patients were divided into mild-to-moderate and severe stenosis groups according to the degree of coronary artery stenosis. Clinical parameters, carotid ultrasound features, and Plaque-RADS classification were compared between the two groups. A multivariate logistic regression model was constructed, and its predictive performance was assessed using receiver operating characteristic curves.

Results Univariate analysis revealed that the proportion of males, patients with diabetes and hyperlipidemia, and smokers was significantly higher in the severe stenosis group, accompanied by greater plaque thickness as well as lower E_max and E_mean. Statistically significant differences were also observed between the two groups in plaque location, Plaque-RADS classification, and plaque stability distribution (P＜0.05). Specifically, type Ⅱ plaques predominated in the mild-to-moderate stenosis group, whereas the severe stenosis group had a higher proportion of type Ⅲ plaques and vulnerable plaques. Multivariate logistic regression analysis demonstrated that male, diabetes, and type Ⅲ–Ⅳ plaques were independent risk factors for severe coronary artery stenosis, while E_max served as a protective factor. The predictive model constructed by the above indicators exhibited favorable predictive performance (AUC＝0.838).

Conclusions The combination of Plaque-RADS classification, E_max, sex, and comorbid diabetes has certain predictive value for the severity of coronary artery stenosis.