Identifying patients with symptomatic carotid artery disease at high and low risk of severe myocardial infarction and cardiac death

被引:23
作者
Gates, PC
Eliasziw, M
Algra, A
Barnett, HJM
Gunton, RW
机构
[1] John P Robarts Res Inst, London, ON N6A 5K8, Canada
[2] Geelong Hosp, Dept Neurosci, Geelong, Vic, Australia
[3] Univ Melbourne, Dept Med, Melbourne, Vic, Australia
[4] Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada
[5] Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada
[6] Univ Med Ctr Utrecht, Dept Neurol, Utrecht, Netherlands
[7] Univ Med Ctr Utrecht, Julius Ctr Gen Practice & Patient Oriented Res, Utrecht, Netherlands
[8] Univ Western Ontario, Dept Med, London, ON, Canada
关键词
carotid artery diseases; heart disease; ischemia; prognosis;
D O I
10.1161/01.STR.0000030110.05246.2C
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-The extent of cardiac investigation required in patients with coexistent symptomatic carotid and cardiac disease is unsettled. This study compared the outlook for patients symptomatic from carotid stenosis with and without a history of symptomatic ischemic heart disease (IHD). Methods-The risk of combined outcome of severe myocardial infarction and cardiac death was evaluated in patients from the North American Symptomatic Carotid Endarterectomy Trial. Results-A total of 1124 patients had a history of symptomatic IHD and 1691 did not. The median age was 66 years; 70% were male. With history of IHD at entry, the 5-year risk of combined outcome of severe myocardial infarction and cardiac death was 16.5% (95% CI, 13.9 to 19.0). Without history at entry, risk was 6.7% (95% CI, 5.1 to 8.3). Risk of unheralded severe MI and cardiac death was only 3.3%. One hundred ninety-four patients had :4 of the following risk factors: age greater than or equal to75 years, history of diabetes, history of hypertension, smoking in past year, left ventricular hypertrophy on ECG, myocardial infarction on ECG, or creatinine > 115 mumol/L. The 5-year risk of severe myocardial infarction or cardiac death increased to 33.9% for patients with greater than or equal to4 risk factors and a history of IHD and to 23.5% for those without history of IHD. Conclusions-Most patients with symptomatic carotid stenosis without symptomatic IHD had a low risk of severe myocardial infarction and cardiac death. With many risk factors, these patients had a risk high enough to warrant cardiac investigations.
引用
收藏
页码:2413 / 2416
页数:4
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