Femoral rather than carotid artery ultrasound imaging predicts extent and severity of coronary artery disease.

BACKGROUND: Pathological, epidemiological and clinical studies indicate that there is coexistence between peripheral vascular disease and coronary artery disease (CAD). B-mode ultrasound of superficial arteries is a non-invasive, valid and reproducible method of directly visualising and assessing carotid and femoral intima-media thickness (IMT) and focal atherosclerosis. AIM: To evaluate the prognostic importance of carotid and femoral vascular changes in predicting CAD severity. METHODS: 410 patients--300 (73.2%) males and 110 (26.8%) females--aged 29-75 years (mean age 55.9+/-9.5 years), referred for elective coronary arteriography, were studied. Clinical examination and laboratory tests were performed, and ultrasound assessments of IMT and atherosclerotic plaque thickness in the common carotid arteries and common femoral arteries were evaluated. RESULTS: Coronary angiography revealed CAD in 81% of patients (85% of males, 70% of females). Cox multiple hazards regression analyses showed a significant relationship between size of atherosclerotic plaques in peripheral arteries and CAD. Odds ratio of CAD associated with every 1-mm plaque thickening ranged from 1.7 to 3.0 (p <0.001) depending on examined artery. Using multiple stepwise regression analysis, the following parameters were found to be independent predictors of one-vessel CAD: myocardial infarction (MI) in anamnesis (OR=22.3; 95% CI 4.0-122.9), typical chest pain (OR=6.4; 95% CI 1.2-34.2), femoral IMT (OR=5.0; 95% CI 1.4-18.4), ex-smoking (OR=5.6; 95% CI 1.1-28.7), and pulse pressure (OR=1.8; 95% CI 1.0-3.2). Independent predictors of multi-vessel CAD were: MI (OR=3.7; 95% CI 1.8-7.5), typical angina (OR=3.3; 95% CI 1.7-6.5), age (OR=1.05; 95% CI 1.01-1.08), number of cigarettes smoked (OR=0.8; 95% CI 0.6-0.9), total cholesterol level (OR=1.1; 95% CI 1.0-1.2), and left femoral plaque thickness (OR=1.4; 95% CI 1.0-2.0). CONCLUSION: Femoral IMT is an independent predictor of a single-vessel disease, whereas femoral atherosclerotic plaque presence indicates advanced CAD.

Primary coronary intervention in diabetic octogenarians with acute ST elevation myocardial infarction.

BACKGROUND: Diabetic patients with acute coronary syndrome (ACS) have higher mortality risk than non-diabetic patients. No data are available on long-term results of interventional treatment of ACS in diabetic patients aged > or =80 years. AIM: To compare the effects of primary angioplasty (pPCI) on short- and long-term outcome in diabetic patients > or =80 years with ST-elevation myocardial infarction (STEMI) compared to those without diabetes mellitus (DM) of similar age. METHODS: In 63 consecutive patients (22% with diabetes mellitus) aged 80-93 years (mean 83+/-3) with ST elevation ACS (ACS-STE) coronary angiography was performed. Severity of coronary atherosclerosis, effects of pPCI, one-day mortality, in-hospital mortality and one-year mortality were studied. RESULTS: Severity of coronary atherosclerosis measured by angiographic Gensini score and author's own score was similar in diabetic and non-diabetic patients (23.25+/-9.6 vs. 20.6+/-10.2; NS, and 9.1+/-6.0 vs. 8.1+/-5.4; NS, respectively). In 78.6% of diabetic subjects and in 69.4% of those without DM, pPCI was performed. Successful pPCI, defined as TIMI 3 flow and residual infarct related stenosis <20%, was obtained in 92.2% of patients with DM compared to 83.7% of non-diabetics (NS). One-day mortality was 7.1 vs. 6.1% (NS), in-hospital mortality was 7.1 vs. 17.4% (NS). Successful pPCI reduced 30-day mortality threefold (OR=0.31; p <0.05). Contrast-induced nephropathy occurred in 35.7% of diabetic patients compared to 26.5% of those without diabetes (NS) Contrast-induced nephropathy increased risk for in-hospital mortality fivefold (p <0.02). No significant correlation between DM or baseline glucose level and in-hospital mortality was found. During one-year follow-up mortality rate in diabetic patients was 38.5% compared to 7.3% of those without diabetes (p <0.01). One-year mortality predictors were: age (OR=1.27; p=0.0047), metabolic syndrome (OR=4.4; p <0.04), type 2 diabetes (OR=5.25; p <0.02), insulin treatment (OR=5.7; p <0.03), baseline glucose level (OR=1.01; p <0.007), maximum CK-mass level (OR=1.006; p <0.05), noninvasive STEMI management (OR=5.0; p <0.02), and stroke (OR=7.5; p <0.006). Stroke (OR=40.0; p <0.005) and diabetes (OR=6.2; p <0.01) were identified by multivariable analysis as independent risk factors of one-year mortality. CONCLUSIONS: In patients with DM aged > or =80 years with ACS-STE, severity of coronary atherosclerosis and in-hospital prognosis after pPCI seems to be similar to subjects in the same age without DM. Diabetes mellitus is an independent risk factor of one-year mortality after successful pPCI.