Abstract Body: Background: Atherosclerosis is systemic, yet disease severity varies markedly across arterial beds and along vessel length. While carotid and peripheral artery disease are associated with coronary artery disease (CAD), whether specific extra-coronary arterial segments provide predictive information for central coronary pathology remains unclear.

Methods: Atherosclerotic burden was graded using the AHA classification for atherosclerosis grading across anatomically defined carotid (internal, external, bifurcation, and common carotid), central (vertebral, coronary, left anterior descending (LAD), and internal thoracic), and peripheral (brachial, radial, femoral, posterior tibial, and dorsalis pedis) arterial segments harvested from 48 cadavers. Segment-level relationships were assessed using Spearman correlation matrices. Ordinal logistic regression was used to evaluate whether carotid and peripheral atherosclerosis predict central coronary disease severity.

Results: Correlation analysis demonstrated strong within-bed clustering and selective cross-bed coupling. Carotid bifurcation and common carotid disease showed moderate correlations with coronary and LAD pathology. Among peripheral arteries, femoral, posterior tibial, and dorsalis pedis segments demonstrated stronger associations with coronary and LAD disease than upper-extremity vessels. In predictive models, increasing peripheral atherosclerotic burden was associated with higher odds of more severe central coronary disease (OR (95% CI): 1.77 (1.02, 3.08); P = 0.043). Carotid atherosclerosis independently predicted central coronary severity with similar magnitude (1.78 (1.03, 3.08); P = 0.039).

Conclusions: Atherosclerosis exhibits spatially structured, segment-specific coupling rather than uniform systemic involvement. Distinct carotid and peripheral arterial segments provide independent predictive information for central coronary disease severity, supporting a region-aware approach to vascular risk stratification.