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High cardiovascular event rates in patients with asymptomatic carotid stenosis: the REACH registry *
Author(s) -
Aichner F. T.,
Topakian R.,
Alberts M. J.,
Bhatt D. L.,
Haring H.P.,
Hill M. D.,
Montalescot G.,
Goto S.,
Touzé E.,
Mas J.L.,
Steg P. G.,
Röther J.
Publication year - 2009
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2009.02614.x
Subject(s) - medicine , asymptomatic , stroke (engine) , cardiology , myocardial infarction , stenosis , proportional hazards model , prospective cohort study , cohort , mechanical engineering , engineering
Background and purpose: 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 ≥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 ≥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). Conclusion: 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.