Forty-five-month follow-up of extracranial carotid arterial disease for new coronary events in elderly patients

Background A prospective study evaluated the prevalence of 40% to 100% extracranial carotid arterial disease (ECD) by carotid duplex ultrasonograms and its association with coronary artery disease (CAD) and incidence of new coronary events in 949 patients with a mean age of 82 ± 8 years. Methods Technically adequate bilateral carotid duplex ultrasonograms were obtained in 949 unselected patients, mean age 82 ± 8 years, in a chronic care facility. The prevalence of CAD and incidence of coronary events were determined in patients with and without ECD. Follow-up was 45 ± 22 months. Data were analyzed by chi-square analyses. Results CAD was present in 87 of 150 patients (58%) with ECD and in 314 of 799 patients (39%) without ECD (P < 0.001). Coronary events occurred in 70 of 87 patients (80%) with ECD and CAD (group A), in 188 of 314 patients (60%) with CAD and no ECD (group B), in 28 of 63 patients (44%) with ECD and no CAD (group C), and in 133 of 485 patients (27%) with no ECD and no CAD (group D). Significant P values were P < 0.001 comparing A with B, A with C, A with D, and B with D; P < 0.01 comparing C with D; and P < 0.025 comparing B with C. Conclusions Patients with ECD have a higher prevalence of CAD and a higher incidence of coronary events than patients without ECD. Patients with CAD and ECD have a higher incidence of coronary events than patients with CAD and no ECD. Patients with ECD and no CAD have a higher incidence of coronary events than patients with no ECD and no CAD.