|Regional use of combined carotid endarterectomy/coronary artery bypass graft and the effect of patient risk.|
|PMID: 22560308 Owner: NLM Status: MEDLINE|
|INTRODUCTION: Although carotid artery stenosis and coronary artery disease often coexist, many debate which patients are best served by combined concurrent revascularization (carotid endarterectomy [CEA]/coronary artery bypass graft [CABG]). We studied the use of CEA/CABG in New England and compared indications and outcomes, including stratification by risk, symptoms, and performing center.
METHODS: Using data from the Vascular Study Group of New England from 2003 to 2009, we studied all patients who underwent combined CEA/CABG across six centers in New England. Our main outcome measure was in-hospital stroke or death. We compared outcomes between all patients undergoing combined CEA/CABG to a baseline CEA risk group comprised of patients undergoing isolated CEA at non-CEA/CABG centers. Further, we compared in-hospital stroke and death rates between high and low neurologic risk patients, defining high neurologic risk patients as those who had at least one of the following clinical or anatomic features: (1) symptomatic carotid disease, (2) bilateral carotid stenosis >70%, (3) ipsilateral stenosis >70% and contralateral occlusion, or (4) ipsilateral or bilateral occlusion.
RESULTS: Overall, compared to patients undergoing isolated CEA at non-CEA/CABG centers (n = 1563), patients undergoing CEA/CABG (n = 109) were more likely to have diabetes (44% vs 29%; P = .001), creatinine >1.8 mg/dL (11% vs 5%; P = .007), and congestive heart failure (23% vs 10%; P < .001). Patients undergoing CEA/CABG were also more likely to take preoperative beta-blockers (94% vs 75%; P < .001) and less likely to take preoperative clopidogrel (7% vs 25%; P < .001). Patients undergoing CEA/CABG had higher rates of contralateral carotid occlusion (13% vs 5%; P = .001) and were more likely to undergo an urgent/emergent procedure (30% vs 15%; P < .001). The risk of complications was higher in CEA/CABG compared to isolated CEA, including increased risk of stroke (5.5% vs 1.2%; P < .001), death (5.5% vs 0.3%; P < .001), and return to the operating room for any reason (7.6% vs 1.2%; P < .001). Of 109 patients undergoing CEA/CABG, 61 (56%) were low neurologic risk and 48 (44%) were high neurologic risk but showed no demonstrable difference in stroke (4.9% vs 6.3%; P = .76), death, (4.9 vs 6.3%; P = .76), or return to the operating room (10.2% vs 4.3%; P = .25).
CONCLUSIONS: Although practice patterns in the use of CEA/CABG vary across our region, the risk of complications with CEA/CABG remains significantly higher than in isolated CEA. Future work to improve patient selection in CEA/CABG is needed to improve perioperative results with combined coronary and carotid revascularization.
|Douglas W Jones; David H Stone; Mark F Conrad; Yvon R Baribeau; Benjamin M Westbrook; Donald S Likosky; Jack L Cronenwett; Philip P Goodney|
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|Type: Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2012-05-05|
|Title: Journal of vascular surgery Volume: 56 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2012 Sep|
|Created Date: 2012-08-24 Completed Date: 2012-11-02 Revised Date: 2014-04-14|
Medline Journal Info:
|Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States|
|Languages: eng Pagination: 668-76 Citation Subset: IM|
|Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.|
|APA/MLA Format Download EndNote Download BibTex|
Aged, 80 and over
Carotid Stenosis / complications, mortality, surgery*
Coronary Artery Bypass / adverse effects, mortality, utilization*
Coronary Stenosis / complications, mortality, surgery*
Endarterectomy, Carotid / adverse effects, mortality, utilization*
Outcome and Process Assessment (Health Care)*
Physician's Practice Patterns / utilization*
Practice Guidelines as Topic
Severity of Illness Index
Stroke / etiology
|1K08HL05676-01/HL/NHLBI NIH HHS; K08 HL105676/HL/NHLBI NIH HHS; L32 MD006323/MD/NIMHD NIH HHS|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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