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Preoperative Coronary Stenosis Is a Determinant of Early Vascular Outcome after Carotid Endarterectomy.

Kim JH, Heo SH, Nam HJ, Youn HC, Kim EJ, Lee JS, Kim YS, Kim HY, Koh SH, Chang DI - J Clin Neurol (2015)

Bottom Line: The benefit of carotid endarterectomy (CEA) is directly influenced by the risk of perioperative adverse outcomes.One hundred and fifty-three consecutive CEAs from our hospital records were included in this analysis.An adverse vascular outcome occurred in 8 of the 153 CEAs, with 6 strokes, 2 MIs, and 3 deaths.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Korea.

ABSTRACT

Background and purpose: The benefit of carotid endarterectomy (CEA) is directly influenced by the risk of perioperative adverse outcomes. However, patient-level risks and predictors including coronary stenosis are rarely evaluated, especially in Asian patients. The aim of this study was to determine the relationship between the vascular risk factors underlying CEA, including coronary stenosis, and postoperative outcome.

Methods: One hundred and fifty-three consecutive CEAs from our hospital records were included in this analysis. All patients underwent coronary computed tomography angiography before CEA. Data were analyzed to determine the vascular outcomes in patients with mild-to-moderate vs. severe coronary stenosis and high vs. standard operative risk, based on the criteria for high operative risk defined in the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial. The vascular outcome was defined as the occurrence of postoperative (≤30 days) stroke, myocardial infarction (MI), or death.

Results: An adverse vascular outcome occurred in 8 of the 153 CEAs, with 6 strokes, 2 MIs, and 3 deaths. The vascular outcome differed significantly between the groups with mild-to-moderate and severe coronary stenosis (p=0.024), but not between the high- and standard-operative-risk groups (stratified according to operative risk as defined in the SAPPHIRE trial). Multivariable analysis adjusting for potent predictors revealed that severe coronary stenosis (odds ratio, 6.87; 95% confidence interval, 1.20-39.22) was a significant predictor of the early vascular outcome.

Conclusions: Severe coronary stenosis was identified herein as an independent predictor of an adverse early vascular outcome.

No MeSH data available.


Related in: MedlinePlus

Preoperative coronary workups for all procedures (n=153). CAG: coronary angiography, CCTA: coronary computed tomography angiography, CEA: carotid endarterectomy, PCI: percutaneous coronary intervention.
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Figure 1: Preoperative coronary workups for all procedures (n=153). CAG: coronary angiography, CCTA: coronary computed tomography angiography, CEA: carotid endarterectomy, PCI: percutaneous coronary intervention.

Mentions: One hundred and fifty-three CEA procedures were performed in 141 patients. The baseline characteristics of those patients are given in Table 1. Only the preexistence of severe coronary stenosis significantly affected the postoperative outcome. Preoperative CCTA was performed before CEA in all patients, and CAG was performed in 68 CEAs (44.4%). CAG was performed in 39 of the 57 subjects with severe coronary stenosis based on CCTA. Of those, 35 subjects (89.7%) had severe coronary stenosis based on CAG, and were treated with a percutaneous coronary intervention (PCI). In 96 subjects without severe coronary stenosis based on CCTA, 29 subjects underwent CAG in response to a history of chest pain or a positive stress test. Of those, 17 subjects (58.6%) were observed to have coronary stenosis based on CAG. Of the 52 procedures in subjects with severe coronary stenosis based on CAG, preoperative PCI was performed in 44 procedures. Eight subjects did not undergo PCI because of long-segment stenosis, or other specific reasons, such as patient refusal. The patterns of the coronary lesions revealed by preoperative coronary workups are summarized in Fig. 1.


Preoperative Coronary Stenosis Is a Determinant of Early Vascular Outcome after Carotid Endarterectomy.

Kim JH, Heo SH, Nam HJ, Youn HC, Kim EJ, Lee JS, Kim YS, Kim HY, Koh SH, Chang DI - J Clin Neurol (2015)

Preoperative coronary workups for all procedures (n=153). CAG: coronary angiography, CCTA: coronary computed tomography angiography, CEA: carotid endarterectomy, PCI: percutaneous coronary intervention.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596101&req=5

Figure 1: Preoperative coronary workups for all procedures (n=153). CAG: coronary angiography, CCTA: coronary computed tomography angiography, CEA: carotid endarterectomy, PCI: percutaneous coronary intervention.
Mentions: One hundred and fifty-three CEA procedures were performed in 141 patients. The baseline characteristics of those patients are given in Table 1. Only the preexistence of severe coronary stenosis significantly affected the postoperative outcome. Preoperative CCTA was performed before CEA in all patients, and CAG was performed in 68 CEAs (44.4%). CAG was performed in 39 of the 57 subjects with severe coronary stenosis based on CCTA. Of those, 35 subjects (89.7%) had severe coronary stenosis based on CAG, and were treated with a percutaneous coronary intervention (PCI). In 96 subjects without severe coronary stenosis based on CCTA, 29 subjects underwent CAG in response to a history of chest pain or a positive stress test. Of those, 17 subjects (58.6%) were observed to have coronary stenosis based on CAG. Of the 52 procedures in subjects with severe coronary stenosis based on CAG, preoperative PCI was performed in 44 procedures. Eight subjects did not undergo PCI because of long-segment stenosis, or other specific reasons, such as patient refusal. The patterns of the coronary lesions revealed by preoperative coronary workups are summarized in Fig. 1.

Bottom Line: The benefit of carotid endarterectomy (CEA) is directly influenced by the risk of perioperative adverse outcomes.One hundred and fifty-three consecutive CEAs from our hospital records were included in this analysis.An adverse vascular outcome occurred in 8 of the 153 CEAs, with 6 strokes, 2 MIs, and 3 deaths.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Korea.

ABSTRACT

Background and purpose: The benefit of carotid endarterectomy (CEA) is directly influenced by the risk of perioperative adverse outcomes. However, patient-level risks and predictors including coronary stenosis are rarely evaluated, especially in Asian patients. The aim of this study was to determine the relationship between the vascular risk factors underlying CEA, including coronary stenosis, and postoperative outcome.

Methods: One hundred and fifty-three consecutive CEAs from our hospital records were included in this analysis. All patients underwent coronary computed tomography angiography before CEA. Data were analyzed to determine the vascular outcomes in patients with mild-to-moderate vs. severe coronary stenosis and high vs. standard operative risk, based on the criteria for high operative risk defined in the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial. The vascular outcome was defined as the occurrence of postoperative (≤30 days) stroke, myocardial infarction (MI), or death.

Results: An adverse vascular outcome occurred in 8 of the 153 CEAs, with 6 strokes, 2 MIs, and 3 deaths. The vascular outcome differed significantly between the groups with mild-to-moderate and severe coronary stenosis (p=0.024), but not between the high- and standard-operative-risk groups (stratified according to operative risk as defined in the SAPPHIRE trial). Multivariable analysis adjusting for potent predictors revealed that severe coronary stenosis (odds ratio, 6.87; 95% confidence interval, 1.20-39.22) was a significant predictor of the early vascular outcome.

Conclusions: Severe coronary stenosis was identified herein as an independent predictor of an adverse early vascular outcome.

No MeSH data available.


Related in: MedlinePlus