Carotid plaque composition in stable and unstable coronary artery disease

Background Several pieces of evidence suggest that formation of complex atheromatous plaques may be influenced not only by local but also by systemic factors. Methods Twenty-five patients (16 men/9 women, age 63 +/- 10 years) with stable coronary artery disease (sCAD) and 61 (41 men/20 women, age 66 +/- 16 years) with acute coronary syndromes (ACSs) underwent carotid ultrasonography within 2 days of cardiac catheterization. Complex coronary plaques were associated with intraluminal filling defect consistent with thrombus, ulceration, or irregularity. Complex carotid plaques had one or more of the following features: (a) ulceration, (b) irregular surface, (c) mobile thrombi on plaque surface, (cl) predominant echolucency, and (e) heterogeneity with introplaque echolucent areas. Results Carotid intimamedia thickness and luminal diameter were not significantly different between patients with sCAD and those with ACS (0.95 +/- 0.22 vs 1.0 +/- 0. 15 mm [P=.23] and 6.1 +/- 0.89 vs 6.20 +/- 0.77 min [P=.60], respectively), whereas the interadventitial diameter was slightly greater in the latter (7.93 +/- 1.05 vs 8.40 +/- 0.97 mm, P=.0496). Both complex coronary plaques and complex carotid plaques were more common in patients with ACS than in those with sCAD (n=52 [85.2%] vs n=6 [24%] [P6-fold in patients with ACS compared with those with sCAD (OR 6.61, 95% CI 2.24-19.32). Conclusions Complex coronary plaques are associated with complex carotid plaques and the high prevalence of both plaque types in patients with ACS is indicative of a systemic process contributing to complex plaque formation and instability

Supplementary Material for: Contemporary Antiplatelet Treatment in Acute Coronary Syndrome Patients with Impaired Renal Function Undergoing Percutaneous Coronary Intervention

<p><b><i>Objectives:</i></b> To assess the clinical impact of impaired renal function (IRF), in “real-world” acute coronary syndrome (ACS) patients, receiving clopidogrel, prasugrel, or ticagrelor. <b><i>Methods:</i></b> This was a prospective, observational, multicenter, cohort study of ACS patients undergoing percutaneous coronary interventions (PCI) with IRF (creatinine clearance <60 mL/min by Cockroft-Gault equation), who were recruited into the Greek Antiplatelet Registry (GRAPE). Patients were followed-up until 1 year for major adverse cardiovascular events (MACE; a composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke) and BARC (Bleeding Academic Research Consortium) bleeding. <b><i>Results:</i></b> Out of 2,047 registered patients, there were 344 (16.8%) with IRF. At the 1-year follow-up, MACE occurred in 18.6 and 6.2% of those patients with and without IRF, respectively: adjusted hazard ratio (HR) = 2.13 (95% confidence interval, CI 1.16-3.91), <i>p</i> = 0.02. IRF patients were also at higher risk of death and BARC type ≥2 and ≥3 bleeding: adjusted HR = 3.55 (95% CI 1.73-7.27), <i>p</i> = 0.001; HR = 2.75 (95% CI 1.13-6.68), <i>p</i> = 0.03; and HR = 6.02 (95% CI 2.30-15.77), <i>p</i> < 0.001, respectively. Combined MACE and BARC type ≥2 bleeding occurred in 34.0 and 14.0% of those with and without IRF, respectively: adjusted HR = 2.65 (95% CI 1.36-5.16), <i>p</i> = 0.004. At discharge, clopidogrel was more frequently prescribed in IRF patients (61.0 vs. 33.1%, <i>p</i> < 0.001). <b><i>Conclusions:</i></b> Real-world ACS patients with IRF subjected to PCI demonstrate higher thrombotic and bleeding risks than patients with normal renal function.</p