CT-angiography permits the reliable quantification of calcification of carotid plaques. A lower content of calcium in carotid plaques, as well as its distribution in the base of the lesion, was associated with a greater prevalence of neurological symptoms. These parameters may be useful to identify those patients at higher risk of stroke.

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Introduction Several studies have showed a substantial risk of death in patients with MINOCA. However, little is still known about the causes of death in these patients compared to patients with MI with significant coronary lesions. On the other hand, using statins treatment in MINOCA has demonstrated to have prognosis benefit in a recent observational. In this study, we aim to describe the previous aspects in a contemporary cohort of patients with AMI. Methods We analyzed retrospective data from 4,499 consecutive patients discharged with a confirmed diagnosis of AMI from January/2010 to December/2016. Patients with coronary lesions <50% were classified as MINOCA. Patients with Tako-Tsubo syndrome were excluded. The time to death in patients with MINOCA vs MI-OCA was analyzed and the causes of death (CV death and non-CV death) were compared. When the cause of death was unknown, it was classified as unknown. The log-rank test was used to find differences in death rate between both groups. The effect of statin treatment was tested. Results 643 patients (14.3%) were diagnosed with MINOCA. The prevalence of women was higher among patients with MINOCA (42.8% vs. 22.6%, p<0.01). The MINOCA were older (69±13 years vs. 66±13 years, p<0.01) with a higher prevalence of hypertension (70.85% vs. 65.3%, p=0.007), previous stroke (10.65 vs. 7.0%; p=0.001), COPD (14.0% vs. 9.95, p=0.002) and cancer history (9.2% vs. 7.6%, p=0.16). In contrast, the MINOCA patients had a lower prevalence of active smoking (19.9% vs. 35%, p<0.01), DM (33.0 vs. 29.4%, p=0.07), dyslipidemia (65.8% vs. 66.3%, p=0.81) and peripheral arteriography (7.3% vs. 8.3%, p=0.41). STEMI was the most frequent form of hospital presentation in the MINOCA cohort (41.95% vs. 19.1%). LVEF was higher in the MINOCA cohort (55% ± 11% vs. 52% ± 10%, p=0.006). At discharge, 86.5% of MINOCAs were treated with statin vs. 86.5% in MI-OCA. The statins prescribed at discharge were of higher potency at 78.2% in MINOCA vs. 88.1% in MI-OCA, moderate potency in 16.1% vs 9.5%, and lower potency in 5.7% vs. 2.4%, respectively (p=0.001). During a median follow-up of 15 months (IQR: 12.6–26.0 months), there were 383 deaths (8.5%), of which 314 occurred in the MI-OCA cohort (8.2%) and 69 occurred in MINOCA cohort (11.1%); p=0.001. 47.8% (n=33/69) were deaths of CV origin in the MINOCA group vs. 48.1% (n=151/314) in the MI-OCA group (p=0.61). The cause of death could not be determined in 6 patients (8.7%) with MINOCA and in 46 (14.7%) with MI-OCA (p=0.19). No benefit of the statin treatment of any potency was observed in MINOCA (HR=0.8 [95% CI: 0.4–1.6]) whether there was benefit in MI-OCA group (HR=0.7 [95% CI 0.5–0.98]). Conclusions There is a considerable difference in the comorbidities between MINOCA and MI-OCA, but a similar rate of death of CV origin in the medium term. The lack of benefit of statin treatment has to be confirmed in other larger studies.

Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin II receptor blockers (ARB) showed comparable survival results in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). However, there is lack of evidence of the comparative effectiveness in preserved LVEF patients after an acute coronary syndrome (ACS). The aim of this study was to evaluate whether the selection between ACEi and ARB in preserved LVEF after an ACS confers a prognostic benefit, based on real life results. We analyzed a cohort of 3006 contemporary patients with LVEF ≥40% after an ACS. A propensity score matching and Cox regression analysis were performed to assess the association between treatment and events (death, acute myocardial infarction [AMI], HF, and combined event) for a mean follow-up of 3.6 ± 2.1 years. We found no significant differences between ACEi/ARB for all-cause mortality (hazard ratio [HR] for ARB: 0.95, 95% CI: 0.70-1.29), AMI (HR for ARB: 1.34, 95% CI: 0.95-1.89), HF (HR for ARB: 1.11, 95% CI: 0.85-1.45), or combined end point (death, AMI and HF: HR for ARB: 1.14, 95% CI: 0.92-1.40). In conclusion, there are no prognostic differences between the use of ACEi and ARB in patients with LVEF ≥40% after ACS. Further prospective studies are needed to confirm our results.