Factors of progression of atherosclerosis in the carotid arteries in elderly patients with acute coronary syndrome

Aim. To study the severity of atherosclerosis of the carotid arteries during the period of hospitalization and one year after acute coronary syndrome (ACS) in elderly patients and to determine the factors influencing the progression of the atherosclerotic process.

Materials and methods. The study included 105 patients with ACS aged 75 and over and with the presence of atherosclerosis of the carotid arteries according to duplex scanning. The data of 86 patients were re-analyzed one year after ACS. The degree of stenosis of the carotid arteries, the structure of atherosclerotic plaques (ASP) with the determination of signs of instability were assessed during the period of hospitalization and one year after ACS.

Results. One year after ACS, 56,9 % patients had adverse clinical outcomes, including death. Progression of the atherosclerotic process was detected in 31,4 %, regression – 7,2 %, unchanged – 61,4 %. During the period of hospitalization and one year after ACS, the regression of signs of instability was found when assessing the structure of ASP: heterogenous structure – 29 and 19,5 % (p = 0,019), irregular surface – 9,2 and 4,9 % (p = 0,605), hypoechogenic component – 27,6 and 17,3 % (p = 0,012), signs of local calcification – 14,7 and 8,8 % (p = 0,075), ulcerated ASP – 2,8 and 1,3 % (p = 0,329). The relationship between the progression of atherosclerosis and adherence to therapy was found. The presence of stenoses of the carotid arteries of 50 % and more: OR = 2,53 (95 % CI: 0,65–9,86, p <0,001) and heterogenous structure of ASP: OR = 2,4 (95 % CI: 0,86–6,73, p = 0,026) can affect the progression of the atherosclerotic process.

Conclusion. 56,9 % of elderly patients one year after ACS had adverse clinical outcomes. Progression of atherosclerosis of the carotid arteries was in 31,4 %. Regression of signs of instability was detected one year after ACS when assessing the structure of ASP in the carotid arteries. The relationship between the progression of ASP and adherence to therapy was found. The greatest influencing factors on the progression of the atherosclerotic process in the carotid arteries have been determined, which can help reduce the risk of developing cerebrovascular and recurrent cardiovascular events. 

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