title: Impact of carotid atherosclerosis on the risk of adverse cardiac events in patients with and without coronary disease.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Arie
authors.initials: A
authors.lastname: Steinvil
authors.affiliation: 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.
authors.forename: Ben
authors.initials: B
authors.lastname: Sadeh
authors.affiliation: 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.
authors.forename: Natan M
authors.initials: NM
authors.lastname: Bornstein
authors.affiliation: 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.
authors.forename: Ofer
authors.initials: O
authors.lastname: Havakuk
authors.affiliation: 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.
authors.forename: Sharon
authors.initials: S
authors.lastname: Greenberg
authors.affiliation: 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.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Arbel
authors.affiliation: 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.
authors.forename: Maayan
authors.initials: M
authors.lastname: Konigstein
authors.affiliation: 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.
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.affiliation: 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.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
authors.affiliation: 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. amirh@tlvmc.gov.il.
authors.forename: Amir
authors.initials: A
authors.lastname: Halkin
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
keywords: carotid stenosis; coronary artery disease