Carotid versus coronary atherosclerosis burdens in acute compared with chronic symptomatic coronary artery disease

Area of Science:

• Cardiovascular Medicine
• Medical Imaging
• Atherosclerosis Research

Background:

• Predicting coronary events is challenging, with carotid atherosclerosis potentially serving as a surrogate marker for coronary risk.
• Simultaneous occurrence of carotid and coronary artery disease is known, though the association strength varies with clinical presentation.

Purpose of the Study:

• To investigate and compare carotid and coronary atherosclerosis burdens in men with new-onset unstable coronary artery disease (CAD) presenting with acute ST-segment elevation myocardial infarction (STEMI) versus those with long-standing severe chronic stable angina (CSA).

Main Methods:

• Employed 3D-volumetric carotid magnetic resonance imaging and coronary angiography-derived modified CASS-50 score to measure bilateral carotid artery and 3-vessel coronary artery atherosclerosis burdens within one month.
• Enrolled 50 men with STEMI and 50 age-matched men with CSA, all diagnosed with carotid atherosclerosis.

Main Results:

• Carotid atherosclerosis burden was significantly greater in STEMI patients compared to CSA patients (wall volume: 196.2 ± 44.4 vs. 169.2 ± 38.0 mm³/4 mm, p = 0.002).
• Conversely, coronary artery atherosclerosis burden was significantly higher in CSA patients than in STEMI patients (modified CASS-50 score: 3 vs. 1, p < 0.0001).
• The normalized wall index (NWI) of the internal carotid artery showed an association with the modified CASS-50 score in both STEMI (ρ = 0.40, p = 0.022) and CSA (ρ = -0.39, p = 0.031) groups.

Conclusions:

• Carotid atherosclerosis is universally present in patients with CAD.
• The extent of atherosclerosis in both carotid and coronary arteries varies significantly depending on the clinical presentation (STEMI vs. CSA).
• These findings highlight the differential patterns of atherosclerosis based on acute versus chronic coronary syndromes.