title: Carotid atherosclerotic plaque instability in patients with acute myocardial infarction.
abstract: The instability of atherosclerotic plaque is partly determined by local factors, but systemic factors such as infection, inflammation, autoimmunity or genes might also be important. We aimed to analyze whether patients with acute myocardial infarction (AMI) might have a higher proportion of unstable plaques in the carotid arteries compared with patients who had had no acute coronary events.
  
  
  METHODS
  Sixty-nine consecutive patients with AMI (Group 1) and 95 patients without acute coronary events (Group 2) had carotid artery duplex ultrasounds. Carotid atherosclerosis was quantified by number of plaques in the two carotid arteries, intimal media thickening and degree of maximal stenosis. According to their morphology, plaques were divided into stable (fibrocalcific) and unstable (soft and/or not homogeneous).
  
  
  RESULTS
  The two groups did not differ as regards age (66+/-8 vs. 68+/-19; p=0.3), female sex (13% vs. 21%; p=0.3), mean number of carotid plaques (2.8+/-1 vs. 2.5+/-2; p=0.2), degree of stenosis (59+/-2% vs. 36+/-1%; p=0.2) or intimal media thickening (1.04+/-0.2 vs. 1.06+/-0.2; p=0.8). However, Group 1 pts more frequently had unstable carotid plaques compared with Group 2 (43% vs. 15%; p=0.004), and had a greater number of unstable carotid plaques (0.51+/-0.6 vs. 0.16+/-0.4: p<0.0001) and a higher ratio of unstable to stable plaque (19% vs. 8%; p=0.005). In the overall population, logistic regression analysis showed that after adjustment for degree of maximal stenosis, the presence of coronary artery event (AMI pts) predicted the presence of unstable carotid plaque (OR: 4.3 95% CI: 2.0-9.2; p=0.0002).
  
  
  CONCLUSIONS
  Patients with unstable coronary artery disease expressed clinically as AMI, frequently had unstable atherosclerotic plaques in other arterial sites such as carotid arteries. This finding supports the hypothesis that plaque instability might reflect a systemic process.
authors.affiliation: Dipartimento di Scienze Biomediche e Chirurgiche, Sezione di Cardiologia, University of Verona, Verona, Italy. andrea.rossi@univr.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Franceschini
authors.forename: Massimilano
authors.initials: M
authors.lastname: Fusaro
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Cicoira
authors.forename: Alejandra Amado
authors.initials: AA
authors.lastname: Eleas
authors.forename: Giorgio
authors.initials: G
authors.lastname: Golia
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonapace
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: Piero
authors.initials: P
authors.lastname: Zardini
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D012307:Risk Factors; D014463:Ultrasonography