Concomitant carotid endarterectomy and cardiac surgery does not decrease postoperative stroke rates.
Citation: Journal of Vascular Surgery. 72(2):589-596.e3, 2020 08.PMID: 32067876Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Carotid Stenosis/su [Surgery] | *Coronary Artery Bypass/ae [Adverse Effects] | *Coronary Artery Disease/su [Surgery] | *Endarterectomy, Carotid/ae [Adverse Effects] | *Ischemic Attack, Transient/ep [Epidemiology] | *Stroke/ep [Epidemiology] | Aged | Cardiopulmonary Bypass/ae [Adverse Effects] | Carotid Stenosis/dg [Diagnostic Imaging] | Carotid Stenosis/mo [Mortality] | Coronary Artery Bypass, Off-Pump/ae [Adverse Effects] | Coronary Artery Bypass/mo [Mortality] | Coronary Artery Disease/dg [Diagnostic Imaging] | Coronary Artery Disease/mo [Mortality] | Databases, Factual | Endarterectomy, Carotid/mo [Mortality] | Female | Humans | Incidence | Ischemic Attack, Transient/di [Diagnosis] | Ischemic Attack, Transient/mo [Mortality] | Male | Middle Aged | Retrospective Studies | Risk Assessment | Risk Factors | Stroke/di [Diagnosis] | Stroke/mo [Mortality] | Time Factors | Treatment Outcome | United States/ep [Epidemiology]Year: 2020ISSN:- 0741-5214
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Journal Article | MedStar Authors Catalog | Article | 32067876 | Available | 32067876 |
CONCLUSIONS: Whereas the differences are relatively small, these data suggest that a combined CABG-CEA approach is unlikely to provide significant stroke reduction benefit compared with CABG only. However, comparison with staged approaches merits further investigation. Copyright (c) 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
METHODS: All patients undergoing CABG with known carotid stenosis of >80% were identified from 2011 to 2016. Individuals were stratified by use of cardiopulmonary bypass and whether a concomitant CEA was performed at the time of CABG. Multivariate logistic regression was used to model the probability of combined CABG and CEA. The resulting propensity scores were used to match individuals on the basis of clinical and operative characteristics to evaluate primary (30-day mortality and in-hospital transient ischemic attack and stroke) and secondary (STS morbidity composite events and length of stay) end points, with P < .05 required to declare statistical significance.
OBJECTIVE: The timing of operative revascularization for patients with concomitant carotid artery stenosis and coronary artery disease remains controversial. We examined the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database to evaluate the association of combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) with postoperative outcomes.
RESULTS: After propensity score matching, 994 off-pump CABG patients (497 CABG only and 497 CABG-CEA) and 5952 on-pump CABG patients (2976 CABG only and 2976 CABG-CEA) were identified. For patients who received on-pump operations, those undergoing CABG-CEA had no observed difference in rate of in-hospital stroke (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.72-1.21; P = .6), higher incidence of STS morbidity composite events (OR, 1.15, 95% CI, 1.01-1.31; P = .03), longer length of stay (7.0 [interquartile range, 5.0-9.0] days vs 6.0 [interquartile range, 5.0-9.0] days; P < .005), and no observed difference in 30-day mortality (OR, 1.28; 95% CI, 0.97-1.69; P = .08) compared with those undergoing CABG only. For off-pump procedures, CABG-CEA patients had no observed difference in rate of in-hospital stroke (OR, 0.80; 95% CI, 0.37-1.69; P = .56) compared with those undergoing CABG only.
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