We have previously shown that carotid disease is associated with adverse outcomes of patients with acute coronary syndromes (ACS).¹ The prognostic impact of the sonographic characteristics of carotid plaques, however, remains unclear. The purpose of the present prospective study was to evaluate the relation between ultrasonographic tissue characteristics of carotid plaques and the outcomes of patients with ACS.

METHODS

The initial study population consisted of 398 consecutive patients admitted to our coronary care unit because of an ACS. Of them, 21 patients had significant valvar disease, six patients had a history of carotid surgery, nine patients had a history of stroke, 17 patients were over 85 years old, three patients refused coronary angiography, and five patients were excluded for logistic reasons. Consequently, 337 patients entered the study. ST elevation acute myocardial infarction (MI) was diagnosed in 102 (30%) patients, non-ST elevation acute MI in 147 (44%) patients, and unstable angina in 88 (26%) patients. Along with the coronary angiography, these patients underwent Doppler ultrasonographic assessment of carotid arteries. Both procedures were performed within 15 days of the acute coronary event. According to the decision of attending physicians, the patients were either managed conservatively (n  =  123, 36%), or underwent revascularisation with coronary artery bypass grafting (n  =  92, 27%), or percutaneous coronary intervention (n  =  122, 36%).

Coronary angiography was performed with the standard femoral or brachial technique. The extent of coronary artery disease was classified as one, …