Objective: This meta-analysis aims to compare the relationship between phenotypic manifestation of coronary and carotid atherosclerosis using available imaging techniques. Approach and Results: We searched all electronic databases until October 2020 for studies which reported relationship between carotid and coronary atherosclerosis. The primary end point was correlation between carotid intima-media thickness (CIMT) and carotid plaque features (calcification and lipid-rich necrotic core) with coronary artery disease (CAD). Secondary end points included carotid pathology that predicts CAD. Eighty-nine papers with 22 683 patients comparing carotid and coronary atherosclerosis were included in the analysis. CIMT was increased linearly with severity of CAD irrespective of its significance ( P <0.001), mono versus 2 vessel disease ( P =0.003), and 2 versus multivessel disease ( P <0.001). Carotid plaque presence and calcification were less, and lipid-rich necrotic core was highly prevalent in nonsignificant versus significant CAD ( P <0.001, P =0.03, P <0.001, respectively). Moderate correlation was found between CIMT and severity of CAD ( r =0.60, P <0.001) and the number of diseased vessels ( r =0.49, P <0.001). There was a moderate correlation between carotid and coronary stenosis ( r =0.53, P <0.001) and between carotid and coronary calcification ( r =0.61, P <0.001). CIMT ≥1.0 mm with a summary sensitivity of 77% and summary specificity of 72% and respective values of 80% and 67% for carotid plaque were the best predictors of CAD, irrespective of the technique used for its diagnosis. Conclusions: These results support the concept that atherosclerosis affects both carotid and coronary systems, although not always in identical phenotypic manner. These findings highlight the beneficial examination of carotid arteries whenever CAD is suspected.

Primary percutaneous coronary intervention (PPCI) is one of the important clinical procedures that have been affected by the COVID-19 pandemic. In this study, we aimed to assess the incidence and impact of COVID-19 on in-hospital clinical outcome of ST elevation myocardial infarction (STEMI) patients managed with PPCI. This observational retrospective study was conducted on consecutive STEMI patients who presented to the International Cardiac Center (ICC) hospital, Alexandria, Egypt between 1 February and 31 October 2020. A group of STEMI patients presented during the same period in 2019 was also assessed (control group) and data was used for comparison. The inclusion criteria were established diagnosis of STEMI requiring PPCI.A total of 634 patients were included in the study. During the COVID-19 period, the number of PPCI procedures was reduced by 25.7% compared with previous year (mean 30.0 ± 4.01 vs. 40.4 ± 5.3 case/month) and the time from first medical contact to Needle (FMC-to-N) was longer (125.0 ± 53.6 vs. 52.6 ± 22.8 min, p = 0.001). Also, during COVID-19, the in-hospital mortality was higher (7.4 vs. 4.6%, p = 0.036) as was the incidence of re-infarction (12.2 vs. 7.7%, p = 0.041) and the need for revascularization (15.9 vs. 10.7%, p = 0.046). The incidence of heart failure, stroke, and bleeding was not different between groups, but hospital stay was longer during COVID-19 (6.85 ± 4.22 vs. 3.5 ± 2.3 day, p = 0.0025). Conclusion: At the ICC, COVID-19 pandemic contributed significantly to the PPCI management of STEMI patients with decreased number and delayed procedures. COVID-19 was also associated with higher in-hospital mortality, rate of re-infarction, need for revascularization, and longer hospital stay.

Background Atherosclerosis is a multi‐system pathology with heterogeneous involvement. We aimed to investigate the relationship between the presence and severity of carotid and coronary calcification in a group of patients with coronary artery disease. Methods Sixty‐three patients presenting with unstable angina or positive stress test for myocardial ischaemia were enrolled in this study. All patients underwent CT scanning of the carotid and coronary arteries using the conventional protocol and Agatston scoring system. Risk factors for atherosclerosis were also analyzed for correlation with the extent of arterial calcification. Results Total coronary artery calcium score (CAC) was several times higher than total carotid calcium score (1274 (1018) vs 6 (124), p = 0·0001, respectively). The left carotid calcium score correlated strongly with the right carotid calcium score (rho = 0·69, p < 0·0001). The total CAC score correlated modestly with the total carotid calcium score (rho = 0·34, p = 0·007), in particular with left carotid score (rho = 0·38, p = 0·002), but not with the right carotid score. The left coronary calcium score correlated with the right coronary calcium score (rho = 0·35, p = 0·004), left carotid calcium score (rho = 0·33, p = 0·007) and left carotid calcium score at the bifurcation (rho = 0·34, p = 0·006). While hypertension correlated with carotid calcium score, diabetes and dyslipidaemia correlated with left CAC score. Conclusion In patients with coronary disease, the carotid calcification pattern appeared to be similar between the right and left system in contrast to that of the coronary arteries. CAC correlated only modestly with the carotid score, despite being significantly higher. Hypertension was related to carotid calcium score while diabetes and dyslipidaemia correlated with coronary calcification.

Background and Aim Predicting culprit lesions in acute coronary syndrome (ACS) could be a challenge. The aim of this study was to assess the accuracy of regional wall motion abnormalities (RWMA) using various echocardiographic techniques and ECG changes in predicting the culprit coronary lesion in a group of patients with ACS. Methods In 80 consecutive patients with ACS (age 55Á7 AE 9Á4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle (LV) RWMA, tissue Doppler imaging (TDI) and speckle tracking myocardial strain and strain rate (SR) were performed before intervention. Results Of the 80 patients, one-vessel stenosis (>70%) was present in 53 (66%), two-vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). About 51% of patients had hypertension, 40% diabetes and 23% dyslipidaemia. There was no relationship between individual segmental RWMA and SR. Mean regional SR, but not peak strain, correlated with culprit lesion branch: left anterior descending -LAD (r = 0Á35, P = 0Á005), circumflex LCx (r = 0Á32, P = 0Á03) and right coronary RCA (r = 0Á37, P = 0Á01). Only ECG changes in the LAD territory (r = 0Á26, P = 0Á04) correlated with the culprit lesion. SR of LAD territories ≤À0Á74 was 71% sensitive and 70% specific (AUC = 0Á70, CI = 0Á67-0Á93, P = 0Á01), SR of LCx territories of ≤À0Á67 was 75% sensitive and 63% specific (AUC = 0Á72, CI = 0Á58-0Á87, P = 0Á02) and SR of RCA territories ≤À0Á83 was 73% sensitive and 71% specific (AUC = 0Á80, CI = 0Á66-0Á93, P = 0Á001) in predicting significant stenosis. SR was more accurate than all other techniques in predicting the culprit lesion. Conclusion In ACS, mean regional speckle tracking SR is more sensitive than peak strain, TDI, ECG changes and wall motion abnormalities in detecting significant coronary artery stenosis.