Carotid plaque in STEMI: evidence of a missed opportunity to reclassify risk

Aims: The presence of carotid plaque has been associated with an increased risk for adverse cardiovascular events. It is an early manifestation of subclinical atherosclerosis and can be assessed with a low-cost and widely available study such as carotid ultrasound. It has a class IIa recommendation in current guidelines to reclassify intermediate-risk patients, but there is a paucity of information about the prevalence of carotid disease in patients with acute coronary syndromes. Methods: Observational study in patients admitted for ST-elevation myocardial infarction (STEMI) in a tertiary care center, performing a carotid ultrasound before hospital discharge. Basal characteristics were obtained from electronic medical records. Differential characteristics according to the presence of carotid plaque were analyzed, and the atherosclerotic burden was assessed by the number of diseased vessels. Results: We included 191 patients with STEMI, and 57 (29.8%) had carotid plaque by ultrasound. The only significant difference between patients with or without carotid plaque was their age (54.36 ± 9.93 years versus 61.12 ± 11.48 years, p < 0.001). Patients with subclinical atherosclerotic disease were older, but other risk markers were similar, as was the use of aspirin and statins. The prevalence of carotid disease increased with the number of diseased vessels, indicating a relationship with atherosclerotic burden. Conclusion: The prevalence of carotid plaque detectable by ultrasound is approximately 30% in patients with STEMI. With a traditional risk evaluation, their baseline cardiovascular risk would have been assessed as mild or moderate, and few were treated with aspirin or statins. With a timely carotid ultrasound, they could have been reclassified as high-risk and treated accordingly. Only age was associated with the presence of carotid plaque, highlighting the importance of carotid ultrasound screening in patients greater than 55 years old.