Aims. High-risk carotid plaque remains an important risk factor for atherosclerotic cardiovascular disease (ASCVD). We sought to evaluate the characteristics of carotid plaque and to find out the predictors for high-risk carotid plaque in asymptomatic Koreans. Methods. Subjects ( n = 801 ) without a history of ASCVD from 12 university hospitals in Korea underwent carotid ultrasound. The images were standardized at core laboratory. Morphologic characteristics of plaque were analyzed with laboratory and clinical characteristics. High-risk carotid plaque features included the highest quartile of carotid plaque score (cPS), irregular plaque surface, and hypoechoic and ulcerated plaque. Results. The carotid plaque prevalence was 22.1% (177/801 persons, 293 plaques). The plaque was increased with age ( p < 0.001 ) and conventional ASCVD risk estimator ( p < 0.001 ) and the most frequently found in bulb ( n = 190 , 64.8%). The number of the highest quartile of cPS was 44/177 (24.9%). Irregular plaque was seen in 20.8% out of total plaque (61/293) and was more frequent in the high-risk 10-year ASCVD risk group than in the low-risk group (36.1% vs. 15.8%, p = 0.023 ). Hypoechoic and ulcerated plaques were seen in 14.3% (42/293) and 2% (6/293), respectively. The independent predictors for high-risk plaque were age ( β = 0.052 , p < 0.001 ), HbA1c ( β = 0.182 , p = 0.004 ), male ( β = 0.118 , p = 0.006 ), hypertension ( β = 0.090 , p = 0.032 ), and multiple plaques (OR: 4.810 (two plaques) and 8.621 (three plaques), all p < 0.001 ). Conclusions. This study suggests that high-risk carotid plaque was seen in 12.4% (99/801). The high-risk plaque was associated with diabetes control status reflected by the HbA1c level as well as traditional risk factors in asymptomatic Korean population.

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Background We assessed the long‐term clinical outcomes of an intermediate lesion (IL) according to the presence of a combined culprit lesion (CCL). Hypothesis Long‐term clinical outcomes of IL may be affected by the presence of a CCL. Methods Angiographic findings (n = 1096) and medical chart were reviewed. Patients with IL were divided into two groups: IL without CCL group (n = 383, 64.5%) and IL with CCL group (n = 211, 35.5%). Results The major adverse cardiovascular events (MACE) in the IL with CCL group were significantly higher than those in the IL without CCL group (death: 12.3% vs. 7.0%, myocardial infarction: 3.3%vs. 0.5%, stroke: 6.6% vs. 2.6%, and revascularization [RVSC]: 25.1% vs. 7.6%) during a mean follow up period of 118.4 ± 5.5 months. IL related RVSC rate in the IL with CCL group was higher than that in the IL without CCL group (5.7% vs. 2.1%, p = 0.020). RVSC rate related to IL in total subjects was lower than that related to stented lesion (3.4% vs. 6.4%). The important predictors of total MACE in total subjects were the presence of CCL, IL percent diameter stenosis, hypertension, history of percutaneous coronary intervention, blood glucose and ejection fraction. The predictors of IL related RVSC were IL percent diameter stenosis and IL located in the right coronary artery. Conclusion 10‐year clinical outcomes of an IL (especially IL without CCL) were better than those of stented lesions. This study suggests that the IL can be safely followed up in sites that do not have ability to assess functional study.

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