Cerebral microbleeds and acute coronary syndrome: Screening and progression under dual antiplatelet therapy. Proof of concept study

Introduction Cerebral microbleeds (CMB) are associated with intracerebral hemorrhage. Therefore they may represent a concern if anticoagulant and/or antiplatelet therapy is needed. In addition, some risk factors for developing CMB are similar to those of coronary artery disease including age and hypertension. The aim of this study was to determine the prevalence of CMB in patients with acute coronary syndrome (ACS) and troponin elevation, and to follow their progression at 3 months under dual antiplatelet therapy. Methods This prospective study included patients aged over 65 hospitalized in intensive cardiac care unit in Dijon, France, for ACS with troponin elevation. These patients underwent a first brain MRI (T2* and SWI) within 72 hours of admission, that was repeated 3 months after stenting. Results Sixty-eight patients (29 women and 39 men, mean age 77 years) were included between November 2016 and June 2017. The prevalence of CMB was 22%, with a female predominance of 80% vs. 33% ( P  = 0.002). Patients with at least one acute CMB had significantly lower LDL-Cs and HDL-Cs levels than patients without CMB (1.1 ± 0.45 vs. 1.58 ± 0.96 g/L, P  = 0.013 and 0.48 ± 0.29 vs. 0.68 ± 0.36 g/L, P  = 0.045, respectively) but also renal function impairment (Cockroft-Gault creatinine clearance: 52.7 ± 27.7 vs. 73.4 ± 31.5 mL/min, P  = 0.025), and higher risk CRUSADE score (45.4 ± 12.8 vs. 32.7 ± 14.5, P  = 0.003). Multivariate analysis showed that only female sex was associated with the presence of a CMB on the initial MRI. On repeated MRI, an increase in CMB was observed in 7% of patients, but it was not statistically significant. Conclusion The prevalence of CMB in patients with ACS is high (22% of patients over 65). MRI monitoring showed an increase in CMB numbers, which should be evaluated over longer series, but also over longer periods, taking into account risk factors for CMB development, and duration of antiplatelet treatment. For that purpose, additional patients are recruited in this study.