The efficacy of statin therapy in patients with acute coronary syndromes and concomitant carotid disease.

BACKGROUND

Statins prevent recurrent ischemic coronary events after acute coronary syndrome (ACS) and improve cardiovascular outcome of patients with peripheral artery disease.

AIM

We sought to evaluate the interrelationship between statin use, phenotype of carotid plaques as assessed by ultrasound, and outcome of patients with ACS and concomitant carotid disease.

METHODS

A total of 337 consecutive patients with ACS were assessed by coronary angiography and Doppler ultrasound of the carotid arteries and followed up for a median period of 19 months.

RESULTS

Carotid plaques were detected in 144 (42%) patients. Of these patients, 99 (69%) had echogenic carotid plaques and 45 (31%) had echolucent plaques. The groups did not differ significantly with regard to the lipid profiles, the prevalence of risk factors, and 1-vessel, 2-vessel, or 3-vessel coronary artery disease. During follow-up, 227 (67%) patients were receiving statins. We observed 14 cardiac deaths and 17 myocardial infarctions. After adjustment for treatment strategy (medical therapy or myocardial revascularization), patients with echolucent carotid plaques receiving statin therapy (n = 32, 71%) showed a better event-free survival than did patients with echolucent plaques not treated with statins (log-rank P = .038). In patients with echogenic carotid plaques, the benefit of statin therapy on event-free survival was less evident (log-rank P = .56).

CONCLUSION

In patients with ACS and echolucent carotid plaques, statin therapy is associated with better event-free survival, while in patients with ACS and echogenic carotid plaques no clear benefit of statins is observed.