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Background and Objectives: Both carotid intima-media thickness (CIMT) and carotid plaque are important factors in the primary preventionof cardiac disease. However, it is unclear which one is more important for prognosis, especially in patients with coronary artery disease(CAD). Subjects and Methods: In total, 1426 consecutive CAD patients, proven by angiography, were followed-up for a mean of 85 months. Thestudy population was divided into four groups depending on the CIMT (≥0.83 mm, >95 percentile in Korea) and the presence or absenceof carotid plaque. Results: Patients with carotid plaque and thick CIMT (n=237, 16.6%) had a higher prevalence of hypertension, diabetes mellitus, and dyslipidemiathan those had plaque and thin CIMT (n=213, 14.9%), those without plaque and thick CIMT (n=265, 18.6%) and those withoutplaque and thin CIMT (n=711, 49.9%). The patients with carotid plaque and thick CIMT group had a higher cardiac mortality rate (20.7%vs. 13.1%, 9.4% and 3.9%, respectively, p<0.001) and higher major adverse cardiovascular events (MACE) including death, acute myocardialinfarction, and stroke (27.8% vs. 18.8%, 15.5% and 9.3%, respectively, p<0.001) than any other groups. Multivariate Cox regressionanalysis showed that the presence of carotid plaque with thick CIMT had the highest hazard ratio (HR) compared to other groups (HR 2.23vs. 1.81, 2.01) for cardiac mortality. Also, carotid plaque had a higher HR than CIMT for mortality (HR 1.56 vs. 1.37) and MACE (HR 1.54 vs. 1.36) in the total study population. Conclusion: Carotid plaque is a more important prognostic factor than CIMT in patients with CAD, and adding a thick CIMT to carotidplaque increases the prognostic power for cardiac events.

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