What is the clinical significance of carotid bruits?

Patients with carotid bruits are at an increased risk of myocardial infarction and death from cardiovascular causes. (LOE = 1a-)

Pickett CA, Jackson JL, Hemann BA, Atwood JE. Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis. Lancet 2008;371:1587-1594.  [PMID:18468542]

Meta-analysis (other)

Self-funded or unfunded

Various (meta-analysis)

These researchers searched MEDLINE and EMBASE to identify studies that prospectively assessed outcomes associated with carotid bruits. They specifically only looked for published studies. Two members of the team independently assessed the quality of the studies and 2 others independently extracted the data from the studies. They included 22 studies with more than 17,000 patients followed up for more than 60,000 patient-years. Most of the studies (14) evaluated patients with asymptomatic bruits. Among patients with bruits the rate of myocardial infarction was 3.69 per 100 patient-years (95% CI, 2.97 - 5.40) compared with 1.86 (0.24 - 3.48) in those without bruits. Among patients with bruits the rate of cardiovascular death was 2.85 per 100 patient-years (2.16 - 3.54) compared with 1.11 (0.45 - 1.76) in those without bruits. In spite of the authors' pronouncement, there are no data to suggest that aggressive evaluation, risk factor modification, or interventions based on the presence or absence of bruits will delay these events.