Abstract 4122092: Carotid plaque progression predicts persistent endothelial dysfunction in an infarct-related coronary artery in STEMI survivors

Background and Aim: Persistent coronary endothelial vasomotor dysfunction predicts future coronary events; however, performing multiple invasive endothelial function tests is difficult in actual clinical practice. This study examined whether carotid plaque changes can predict persistent coronary endothelial dysfunction using serial assessments of the coronary vasomotor response to acetylcholine (ACh) in the infarct-related artery (IRA) among patients with ST-elevation acute myocardial infarction (STEMI). Methods: This study included 169 consecutive patients with a first acute STEMI due to the left anterior descending coronary artery (LAD) occlusion who underwent successful reperfusion therapy with percutaneous coronary intervention. The vasomotor response to ACh in the LAD was measured within two weeks of acute myocardial infarction (AMI) (first test) and repeated at six months (second test) after AMI under optimal anti-atherosclerotic therapy. Ultrasonography of the bilateral common carotid artery (CCA) and internal carotid artery (ICA) was performed during the acute phase, and the thickest intima media thickness (IMT) of either artery was measured as the maximum IMT. After six months, the IMT at the site of maximal IMT was measured to determine whether there was an increase or decrease in IMT. Results: Finally, 87 STEMI patients analyzed in this study. At 6 months, 25 patients (28.7%) showed carotid plaque progression. In a multivariable adjusted analysis, carotid plaque progression was identified as an independent predictor of persistent coronary endothelial dysfunction, both in terms of coronary diameter response [OR 3.22, 95% confidence interval1.13 - 9.15, P = 0.03] and coronary flow response [OR 2.65, 95% confidence interval 1.01 - 7.00, P = 0.04]. Conclusions: Carotid plaque progression could independently predict persistent endothelial vasomotor dysfunction in the IRA of STEMI survivors.