0503: Asymptomatic carotid stenosis in patient with acute coronary syndrome: who should be screened?

Abstract

While prevalence and risk factors of carotid stenosis in acute coronary sydrome (ACS) are under investigated, we evaluated patients admitted in our intensive care unit for an ACS in order to define if a screening of this population would be relevant. Systematic carotid Doppler ultrasound screening was done on 102 consecutive patients admitted to the intensive care unit after an ACS with or without ST elevation. Degree of stenosis was determined using NASCET and hemodynamic critera. Clinical data and risk factors of atherosclerosis were collected for all patients. The Chi square test was used for categorical variables and ordinal variables were analyzed using Wilcoxon or Student’s tests. Fifty-two percent of patient (n=53) had at least one carotid stenosis. Mild stenosis (<50%) concerned 45 patients (44%) while 6 patients (6%) had moderate (50-69%) stenosis and 2 patients (2%) had severe (>70%) stenosis. As shown is the table, on univariate analysis, the only predictive factors of moderate and severe stenosis were age >75years (OR=11.8; p=0,016), diabetes mellitus (OR=3.9; p=0,05), history of myocardial infarction (OR=11.4; p=0,002) and left ventricular ejection fraction <40% (OR=6.6; p=0,007). Abstract 0503 – Table: Predictive factors of carotid stenosis >50% in patient with ACS OR IC 95% p Risk Factors Sexe (male) NA NA 0,32 Age >75 years 11,8 1,95-71,5 0,016 Current smoking 0,15 0,03-0,9 0,047 Diabetes mellitus 3,9 0,75-15,9 0,053 Hypertension 3,1 0,7-14,2 0,15 Hyperlipidemia 1,7 0,43-7,05 0,71 Cardiovascular history Peripheral artery disease 6,57 0,76-56,8 0,09 History of stroke or TIA 1,89 0,24-14,9 0,95 History of myocardial infarction 11,4 2,6-49,35 0,002 ACS initial presentation and coronary angiography results STEMI 0,3 0,06-1,28 0,22 Multi-vessel lesions 3,23 0,79-13,1 0,07 Left main artery stenosis 3,15 0,63-15,7 0,17 Left ventricular ejection fraction <40% 6,6 1,58-27,48 0,007 Carotid stenosis is frequent in this population but lesions are often mild and a systematic screening should probably not be recommended. Patients >75 years, diabetics or those with severe coronaropathy seem however to represent a sub-population at risk to have a stenosis ≥50% in which a screening could be proposed during the hospitalisation.