From the Departments of Cardiology (A.S., O.H., Y.A., M.K., A.F., S.B., A.H.), Internal Medicine (B.S., S.G.), and Neurology (N.M.B.), Tel Aviv Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Stroke. 2014 Aug;45(8):2311-7. doi: 10.1161/STROKEAHA.114.005663. Epub 2014 Jun 17.
Carotid atherosclerosis (CA) is reportedly a strong predictor of imminent cardiac events even in the absence of established coronary artery disease (CAD). We examined the differential impact of CA on the risk of major adverse cardiovascular events in patients with and without CAD diagnosed angiographically.
We conducted a follow-up survey of 1391 patients who underwent clinically driven coronary angiography and a same-day carotid ultrasound and Doppler study. Definitions of CAD, CA, and carotid artery stenosis were in accordance with current practice guidelines.
Of 1391 patients, angiographic CAD was present in 1105 (79%) patients. Mean and median follow-up was 1574 and 1702 days, respectively. Rates of the primary composite major adverse cardiovascular event end point were higher among patients with CAD compared with those without CAD (48% versus 20%; P<0.001), whereas the rates of all-cause mortality (10% versus 9%; P=0.81) and stroke (7% versus 5%; P=0.3) did not differ significantly between both groups. Carotid artery stenosis and CA were associated with an increased risk of the composite major adverse cardiovascular event end point among patients without CAD (hazard ratio=3.17 [95% confidence interval, 1.52-6.60]; P<0.01; and hazard ratio=1.69 [0.95-3.01]; P=0.07, respectively) though not in patients with CAD. Carotid artery stenosis was associated with an increased risk of all-cause mortality among patients without CAD (hazard ratio=2.93 [1.09-7.87]; P=0.03]) though not among those with CAD.
CA and carotid artery stenosis are independent predictors of major adverse cardiovascular event in patients undergoing coronary angiography. The prognostic implications of carotid disease are imparted predominantly in patients without pre-existent CAD.
据报道，即使在没有明确的冠状动脉疾病（CAD）的情况下，颈动脉粥样硬化（CA）也是即将发生心脏事件的强有力预测指标。我们检查了 CA 对经血管造影诊断为 CAD 和无 CAD 的患者发生主要不良心血管事件风险的差异影响。
我们对 1391 例因临床需要进行冠状动脉造影和同日颈动脉超声及多普勒检查的患者进行了随访调查。CAD、CA 和颈动脉狭窄的定义符合当前实践指南。
在 1391 例患者中，有 1105 例（79%）患者存在血管造影 CAD。平均和中位随访时间分别为 1574 和 1702 天。与无 CAD 的患者相比，有 CAD 的患者主要复合不良心血管事件终点的发生率更高（48%比 20%；P<0.001），而两组之间全因死亡率（10%比 9%；P=0.81）和卒中（7%比 5%；P=0.3）的发生率无显著差异。在无 CAD 的患者中，颈动脉狭窄和 CA 与复合主要不良心血管事件终点风险增加相关（危险比=3.17 [95%置信区间，1.52-6.60]；P<0.01；和危险比=1.69 [0.95-3.01]；P=0.07），但在 CAD 患者中则不然。在无 CAD 的患者中，颈动脉狭窄与全因死亡率增加相关（危险比=2.93 [1.09-7.87]；P=0.03），但在 CAD 患者中则不然。
在接受冠状动脉造影的患者中，CA 和颈动脉狭窄是主要不良心血管事件的独立预测指标。颈动脉疾病的预后意义主要在没有预先存在 CAD 的患者中显现。
