Abstract
Background: Carotid-artery intima and media thickness (CIMT) is associated with the increased risk of myocardial infarction. We studied whether CIMT predict the prognosis of patients with acute ST-elevation myocardial infarction (STEMI). Methods: A total of 348 acute STEMI patients (men 82.8%, age 59±13 years) treated with primary percutaneous coronary intervention or thrombolysis were prospectively investigated in three centers. Carotid IMT was measured with high-resolution ultrasonography in all patients. The primary endpoint was major adverse cardiac event (death, heart failure, MI, revascularization and stroke) over a median follow-up period of 569 days (1.6 years). Results: The mean CIMT was 0.77±0.14mm and 20.7% of the patients had carotid plaque. Of total patients, 11.8% experienced a major adverse cardiovascular event (MACE). Carotid plaque was independently associated with higher incidence of MACE (adjusted OR 4.76; 95% CI 2.295-9.872; p <0.001). Door-to-balloon time or peak cardiac-specific troponins I (cTnI) did not predict the outcomes of acute STEMI. Area under the ROC curve for CIMT tertile (0.71±0.05) was significantly larger compared to door-to-balloon time (0.59±0.05) or peak cTnI (0.45±0.05) (p <0.001, Fig.1). After adjusting for age, the event rate was 19.0% in the 3rd tertile CIMT (≥0.83mm) group, 12.1% in the 2nd tertile (0.70∼0.82mm) group and 4.3% in the 1st tertile (≤0.69mm) group (p=0.01) (Fig. 2). After adding CIMT to a model with peak cTnI, net proportion of patients reclassified correctly by CIMT was 28.7% and net classification improvement was 0.56 (95% CI 0.46 to 0.66, p <0.001) (Fig. 3). ![Figure][1] Conclusions: Carotid plaque and IMT was a strong prognosticator to predict future cardiovascular events in first STEMI patients than was door-to balloon time or peak cTnI. [1]: pending:yes
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