Common carotid artery intima-media thickness and intracranial pulsatility index in non-ST-elevation acute coronary syndromes.

BACKGROUND: Common carotid intima-media thickness (CIMT) has been related to cardiovascular risk factors, coronary atherosclerosis and a higher risk of myocardial infarction. Evaluation of intracranial arteries by transcranial Doppler explores the presence of vascular dysfunction at this level. We tested the hypothesis that CIMT and Doppler Pulsatility Index (DPI) can be related to the Thrombolysis in Myocardial Infarction (TIMI) risk score for non-ST-elevation acute coronary syndrome (nST-ACS). The relation to the prognosis after an acute event was also assessed.

METHODS: We recruited 126 consecutive patients (80 males; mean age: 66.6 +/- 13.1 years) admitted with nST-ACS. A carotid assessment with bidimensional mode, measuring the CIMT in the posterior wall of the common carotid artery, and a transcranial Doppler assessment of the middle cerebral artery, with measurement of the Pulsatility Index were carried out. Clinical follow-up at 6 months was performed for endpoints (cardiovascular death, recurrent ACS or revascularization).

RESULTS: Fifty-nine patients had an abnormal (> or =0.8 mm) CIMT, whilst 70 patients had an abnormal DPI (> or =1.2). CIMT was correlated with TIMI risk score (Pearson r: 0.26; p = 0.004), whilst abnormal DPI was associated with TIMI risk scale (p < 0.001). Using a logistic regression analysis, the presence of an abnormal CIMT was only related to age > or =65 (p = 0.0012) and diabetes mellitus (p = 0.0028). Abnormal DPI was also associated with age > or =65 (p < 0.0001) and diabetes mellitus (p = 0.0466). Neither CIMT nor DPI were related to 6 months' clinical outcome.

CONCLUSIONS: Patients with nST-ACS have a high prevalence of dates of abnormal DPI, which was associated with increased CIMT. Both variables were related to age and diabetes but not with clinical outcomes.