Résumé
While prevalence and risk factors of carotid stenosis in acute coronary sydrome (ACS) are under investigated, we evaluated patients admitted in our intensive care unit for an ACS in order to define if a screening of this population would be relevant.
Systematic carotid Doppler ultrasound screening was done on 102 consecutive patients admitted to the intensive care unit after an ACS with or without ST elevation. Degree of stenosis was determined using NASCET and hemodynamic critera. Clinical data and risk factors of atherosclerosis were collected for all patients. The Chi square test was used for categorical variables and ordinal variables were analyzed using Wilcoxon or Student’s tests.
Fifty-two percent of patient (n=53) had at least one carotid stenosis. Mild stenosis (<50%) concerned 45 patients (44%) while 6 patients (6%) had moderate (50-69%) stenosis and 2 patients (2%) had severe (>70%) stenosis. As shown is the table, on univariate analysis, the only predictive factors of moderate and severe stenosis were age>75years (OR=11.8; p=0,016), diabetes mellitus (OR=3.9; p=0,05), history of myocardial infarction (OR=11.4; p=0,002) and left ventricular ejection fraction <40% (OR=6.6; p=0,007).Abstract 0503 – Table: Predictive factors of carotid stenosis>50% in patient with ACSORIC 95%pRisk FactorsSexe (male)NANA0,32Age>75 years11,81,95-71,50,016Current smoking0,150,03-0,90,047Diabetes mellitus3,90,75-15,90,053Hypertension3,10,7-14,20,15Hyperlipidemia1,70,43-7,050,71Cardiovascular historyPeripheral artery disease6,570,76-56,80,09History of stroke or TIA1,890,24-14,90,95History of myocardial infarction11,42,6-49,350,002ACS initial presentation and coronary angiography resultsSTEMI0,30,06-1,280,22Multi-vessel lesions3,230,79-13,10,07Left main artery stenosis3,150,63-15,70,17Left ventricular ejection fraction<40%6,61,58-27,480,007
Carotid stenosis is frequent in this population but lesions are often mild and a systematic screening should probably not be recommended. Patients>75 years, diabetics or those with severe coronaropathy seem however to represent a sub-population at risk to have a stenosis≥50% in which a screening could be proposed during the hospitalisation.