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Published on: January 15, 2022
Association between carotid plaque progression and persistent endothelial dysfunction in an infarct-related coronary
Takeo Horikoshi1, Takamitsu Nakamura2, Ryota Yamada2
1Department of Cardiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, 409-3898, Japan. thorikoshi@yamanashi.ac.jp.
Insights
Carotid plaque progression predicts persistent coronary endothelial dysfunction in ST-elevation myocardial infarction (STEMI) survivors. This finding offers a non-invasive marker for adverse cardiovascular events.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Vascular Biology
Background:
- Persistent coronary endothelial dysfunction is a predictor of adverse cardiovascular events.
- Assessing endothelial function invasively is challenging in clinical practice.
- Carotid plaque progression may serve as a surrogate marker for endothelial dysfunction.
Purpose of the Study:
- To investigate the association between carotid plaque progression and persistent coronary endothelial dysfunction in ST-elevation myocardial infarction (STEMI) patients.
- To evaluate carotid plaque progression as a predictor of endothelial dysfunction in the infarct-related artery (IRA).
Main Methods:
- Serial assessment of coronary vasomotor response to acetylcholine (ACh) in the IRA of STEMI patients.
- Measurement of carotid intima-media thickness (IMT) and assessment of plaque progression via ultrasonography.
- Multivariable analysis to identify predictors of persistent coronary endothelial dysfunction.
Main Results:
- Carotid plaque progression was observed in 28.7% of STEMI patients at 6 months.
- Carotid plaque progression independently predicted persistent coronary endothelial dysfunction.
- The association remained significant for both coronary diameter and flow responses to ACh.
Conclusions:
- Carotid plaque progression is a significant predictor of persistent coronary endothelial dysfunction in STEMI survivors.
- This finding suggests a potential non-invasive marker for identifying patients at higher risk of adverse cardiovascular outcomes.
- Further research may explore the clinical utility of carotid plaque assessment in managing STEMI patients.
Abstract:
Persistent coronary endothelial dysfunction predicts future adverse events; however, performing multiple invasive endothelial function tests is difficult in actual clinical practice. This study examined the association between carotid plaque progression and persistent coronary endothelial dysfunction using serial assessments of the coronary vasomotor response to acetylcholine (ACh) in the infarct-related artery (IRA) among patients with ST-elevation acute myocardial infarction (STEMI). This study included 169 consecutive patients with a first STEMI due to the left anterior descending coronary artery (LAD) occlusion who underwent successful percutaneous coronary intervention. The vasomotor response to ACh in the LAD was measured within two weeks after acute myocardial infarction (AMI) (first test) and repeated at six months (second test) after AMI. Ultrasonography of the bilateral common carotid artery and internal carotid artery was performed during the acute phase, and the thickest intima-media thickness (IMT) of either artery was measured as the maximum IMT. After six months, the IMT at the site of maximal IMT was re-measured to determine the carotid plaque progression. Finally, 87 STEMI patients analyzed. At 6 months, 25 patients (28.7%) showed carotid plaque progression. In a multivariable analysis, carotid plaque progression was identified as an independent predictor of persistent coronary endothelial dysfunction, both in terms of coronary diameter response [odd ratio (OR) 3.22, 95% confidence interval (95% CI) 1.13-9.15, p = 0.03] and coronary flow response [OR 2.65, 95% CI 1.01-7.00, p = 0.04]. Independently, carotid plaque progression is linked to persistent endothelial dysfunction in the IRA among STEMI survivors.
