CARDIAC PROGNOSIS OF PATIENTS WITH CAROTID STENOSIS AND NO HISTORY OFCORONARY-ARTERY DISEASE

Background and Purpose Patients with carotid stenosis have a high freq uency of asymptomatic coronary artery disease (CAD). The purpose of th is study of patients with asymptomatic carotid stenosis was to test th e hypothesis that patients without a history of CAD have the same card iac prognosis as patients with a history of CAD. Methods Men enrolled in the Department of Veterans Affairs study on the efficacy of carotid endarterectomy for asymptomatic carotid stenosis underwent a baseline cardiac evaluation (history, physical examination, and electrocardiog ram) to document previous angina or myocardial infarction. Patients we re randomized to medical therapy alone or medical therapy and carotid endarterectomy. Medical therapy consisted of aspirin 650 mg twice dail y and treatment of risk factors. All episodes of angina, myocardial in farction, or sudden death during follow-up (average of 47.9 months) we re recorded. Results Of 444 men enrolled in the study, 200 (45%) had a history of CAD. During the study 86 (43%) of 200 patients with CAD an d 81 (33%) of 244 patients without a history of CAD had cardiac ischem ic events (P = .03). In patients without a history of CAD, the first c ardiac event was myocardial infarction or sudden death in 45 patients (56%). Factors that were independently associated with cardiac events in patients without a history of CAD were diabetes (odds ratio [OR], 2 .14; 95% confidence interval [CI], 1.15 to 3.97), intracranial occlusi ve disease (OR, 2.13; 95% CI, 1.13 to 4.02), and peripheral vascular d isease (OR, 2.04; 95% CI, 1.14 to 3.66). Forty-two percent of patients with two of these factors and 69% of patients with all three factors had cardiac events. Conclusions Men with carotid stenosis and no histo ry of CAD have a lower rate of cardiac events than men with carotid st enosis who have a history of CAD. However, a subgroup of patients with carotid stenosis and no history of CAD who have coexistent intracrani al occlusive disease, diabetes, or peripheral vascular disease have a risk of cardiac events similar to that of patients with a history of C AD.