jurnal carolin sidharta

8/7/2019 jurnal carolin sidharta

1/13

CAROTID BRUITS AND

CEBROVASCULAR DISEASE RISK A

META- ANALYSIS

Karolin D S Sidharta

2009 061 - 252


2/13

BACKGROUND

The physical examination of the patient is afundamental medical skill and one cornerstone isauscultation.

In a recent meta-analysis, has found that thepresence of a carotid bruit significantly increasedthe risk of myocardial infarction andcardiovascular death.

Is there a relationship between the presence of acarotid bruits and the subsequent occurrence ofTIA, Stroke and death from stroke?


3/13

METHOD

Data Sources and SearchesReview the reference list of retrieved articles and review

articles and personal fles of the authors.

Study Selection Identify all published studies that include prognostic

information based on identification of the presence ofcarotid bruit.

To be included in the analysis, studies hd to be onprospective cohorts of asymptomatic adults, englishlanguage, and have extractable cerebrovascular outcomedata.


4/13

Quality Assessment

Studies were assessed with 31 questions that assessed

quality in 7 domains:

Description of patient population characteristic

Completeness of follow-up

Measurement of prognostic factors

Measurement of outcomes

Measurement and adjusment for potentialconfounders

Approprites of the analytic methods

Measurement of a carotid bruits.


5/13

Data Extraction

From each included study were abstracted study

design, year, country, number of included patients,

length of follow up, sex, race, prevalence of

diabetes, hypertension, tobacoo use,

hyperlipidemia, CHF,AF< coronary or peripheral

vascular disease, and the percentage of patients

with carotid stenosis >50%.


6/13

Data synthesis and Analysis

All analyses were performed using STATA 112 (

STATA corportion,college station ,Texas)


7/13

RESULTS

785 potential articles

757 articles exlcuded

28 articles analysis

total patients: 17. 913

The mean Age was 64, 8 years, 56,3% of patients were male


8/13

OUTCOMES

Transient Ischemic Attack

the pooled risk ratio for a TIA in patients withcarotid bruit was 4.00 ( 95% CI, 1.77 to 9.03 )

Stroke The pooled risk ratio for stroke in patients with

carotid bruit was 2.49 ( 95%CI, 1.77 to 3.52)

Death from strokethe pooled risk ratio for death from stroke in patientswith carotid bruit was 2,71 (95% CI,1,33 to 5,53)


9/13

DISCUSSION

CBV , serious medical problem

Caroid bruit may be a candidate for such a tool

for primary preventive. Presence of carotid bruits significantly

increased the likelihood of CBV events.

TIAs, stroke and death 2- 4 fold.


10/13

There are a number of limitations to thefindings:

most of the studies did not collect important

prognostic information such as the incidence ofdiabetes, hypertension , or other vascular risk.

The changes in medical care could influence theprognosis of patients with bruits.

Many of the result were heterogeneity, make itdifficult to now how accurate the pooled outcomesare.


11/13

This test chracteristic describe the relationship

between detection of a carotid bruit and finding

significant stenosis of the carotid artery , not

attempting to assess degree of stenosis by

auscultation, but rather predict risk for future

atherosclerotic CBV outcomes.


12/13

CONCLUSION

1. Patients with carotid bruit have over 4 timesthr risk ofTIA, over twice the risk of stroke,and an increased risk of death from stroke

when compared with defined patient controlswithout carotid bruits.

2. It would be tempting to recommend cliniciansauscultate for carotid bruits and, when found,consider aggressive modifications of CBV riskfactors.


13/13

3. Although it is possible that such a strategy

may reduce TIAs, stroke and death, such a

conclusion awaits prospective interventional

trials, in which the effects of auscultation and

aggressive modification of CBV risk factors

such as aggressive cholesterol reduction are

compared with standard management

Documents

jurnal carolin sidharta