title: Carotid plaque is associated with increased cardiac mortality in patients with coronary artery disease.
abstract: BACKGROUND
  It is still controversial whether carotid plaque is associated with cardiovascular events in patients with coronary artery disease (CAD). The aim of the present study is to evaluate the impact of carotid plaque on long term clinical outcomes especially in patients with CAD.
  
  
  METHODS
  The study population consisted of 1390 consecutive patients with angiographically proven CAD. All subjects underwent carotid scanning 1 day before or after coronary angiogram and were followed up for major adverse cardiovascular events (MACE; death, myocardial infarction, stroke, revascularization, restenosis and hospitalization for heart failure) during a mean of 54.2 ± 23.9 months.
  
  
  RESULTS
  Patients with carotid plaque (n=433) were older, had higher prevalence of cardiovascular risk factors and acute coronary syndrome (34.2% vs. 24.6%, p<0.001) than those without carotid plaque (n=957). On univariate analysis, the presence of carotid plaque was a predictor of cardiac death, hard MACE (death, myocardial infarction and stroke) and total MACE, whereas carotid intima-media thickness (CIMT) was a predictor of total MACE. Multivariate analysis revealed that carotid plaque was associated with cardiac death (HR 6.99, 95% CI 1.88-25.95, p=0.004), hard MACE (HR 1.89, 95% CI 1.18-3.04, p=0.008) and total MACE (HR 1.47, 95% CI 1.13-1.90, p=0.004), whereas CIMT was associated only with total MACE (HR 1.39, 95% CI 1.06-1.81, p=0.017).
  
  
  CONCLUSIONS
  Carotid plaque is a strong predictor of future cardiac death and MACE in patients with CAD. This study suggests that carotid plaque has additional value for secondary prevention and more important prognostic factor than CIMT in patients with CAD.
authors.affiliation: Division of Cardiology, Konyang University Hospital, Daejeon, South Korea.
authors.forename: Hyun Woong
authors.initials: HW
authors.lastname: Park
authors.forename: Wan Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Ki-Hong
authors.initials: KH
authors.lastname: Kim
authors.forename: Dong Ju
authors.initials: DJ
authors.lastname: Yang
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Kim
authors.forename: In Girl
authors.initials: IG
authors.lastname: Song
authors.forename: Taek-Geun
authors.initials: TG
authors.lastname: Kwon
authors.forename: Jang-Ho
authors.initials: JH
authors.lastname: Bae
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000401:mortality*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000175:diagnosis / Q000401:mortality*; D012042:Registries