High cardiovascular event rates in patients with asymptomatic carotid stenosis: the REACH Registry.
OBJECTIVE
Data on current cardiovascular event rates in patients with asymptomatic carotid artery stenosis (ACAS) are sparse. We compared the 1-year outcomes of patients with ACAS > or =70% versus patients without ACAS in an international, prospective cohort of outpatients with or at risk of atherothrombosis.


METHODS
The Reduction of Atherothrombosis for Continued Health Registry enrolled patients with either > or =3 atherothrombotic risk factors or established atherothrombotic disease. We investigated the 1-year follow-up data of patients for whom physicians reported presence/absence of ACAS at the time of inclusion.


RESULTS
Compared with patients without ACAS (n = 30 329), patients with ACAS (n = 3164) had higher age- and sex-adjusted 1-year rates of transient ischaemic attack (3.51% vs. 1.61%, P < 0.0001), non-fatal stroke (2.65% vs. 1.75%, P = 0.0009), fatal stroke (0.49% vs. 0.26%, P = 0.04), cardiovascular death (2.29% vs. 1.52%, P = 0.002), the composite end-point cardiovascular death/myocardial infarction/stroke (6.03% vs. 4.29%, P < 0.0001) and bleeding events (1.41% vs. 0.81%, P = 0.002). In patients with ACAS, Cox regression analyses identified history of cerebrovascular ischaemic events as most important predictor of future stroke (HR 3.21, 95% CI 1.82-5.65, P < 0.0001).


CONCLUSIONS
Asymptomatic carotid artery stenosis was associated with high 1-year rates of cardiovascular and cerebrovascular ischaemic events. Stroke was powerfully predicted by prior cerebrovascular ischaemic events.
Aichner
F T
FT
Academic Teaching Hospital Wagner-Jauregg, Linz, Austria.
Topakian
R
R
Alberts
M J
MJ
Bhatt
D L
DL
Haring
H-P
HP
Hill
M D
MD
Montalescot
G
G
Goto
S
S
Touzé
E
E
Mas
J-L
JL
Steg
P G
PG
Röther
J
J
D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D016893:Carotid Stenosis / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control