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• W4246670274 abstract "Management of significant carotid stenosis in those with symptomatic coronary disease remains controversial. Staged and combined carotid endarterectomy (CEA) with coronary artery bypass (CAB) has been described. Yet, understanding of the additive risks of these approaches is poor. This study sought to assess outcomes in patients with clinically relevant coronary disease undergoing either isolated CEA (ICEA) or combined CEA and CAB (CCAB). All CEAs in the Vascular Quality Initiative from 2003 to 2017 were reviewed. CCABs were identified, as were ICEAs, in patients with unrevascularized stable angina, unstable angina, or myocardial infarction (MI) within 6 months of operation. CCABs were compared with ICEAs as well as with a risk-matched cohort of ICEAs. Primary outcomes included 30-day stroke, death, and MI and these as composite (SDM). Univariate analysis and logistic regression were performed. There were 4042 patients identified, including 2582 ICEAs (64%) and 1460 CCABs (36%); 61% were male, 91% were white, and 39% had symptomatic carotid disease. Overall, stroke was 1.9%; death, 1.8%; and SDM, 4.9%. ICEAs had higher rates of postoperative MI (1.9% vs 0.9%; P = .01) but lower rates of stroke (1.5% vs 2.7%; P = .01), death (1% vs 3%; P < .001), and SDM (4.1% vs 6.4%; P = .001). After regression, predictors of SDM were congestive heart failure (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3-2.5; P < .001), urgent operation (OR, 1.4; 95% CI, 1.01-2.0; P = .04), and CCAB (OR, 1.4; 95% CI, 1.1-1.9; P = .02). After propensity matching, ICEAs continued to have higher rates of perioperative MI (2.6% vs 1.0%; P = .01) and lower rates of death (1% vs 3%; P = .001). However, there were no longer differences in stroke (2% vs 2.8%; P = .21) or SDM (5.2% vs 6.7%; P = .15). Within the matched cohort, predictors of SDM included chronic obstructive pulmonary disease (OR, 1.7; 95% CI, 1.2-2.5; P = .01), congestive heart failure (OR, 1.6; 95% CI, 1.05-2.4; P = .03), and symptomatic carotid disease (OR, 1.5; 95% CI, 1.04-2.2; P = .03). CCAB was not significant (OR, 1.3; 95% CI, 0.9-1.9; P = .14). In patients with unrevascularized, clinically relevant coronary disease, CCAB reduces operative MI but increases risk of stroke and death. After risk adjustment, MI remains higher in ICEA, but differences in 30-day stroke and SDM between ICEA and CCAB are no longer appreciated. These data suggest that CCAB is not inferior to staged risk of ICEA followed by coronary revascularization." @default.
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• W4246670274 date "2018-09-01" @default.
• W4246670274 modified "2023-09-30" @default.
• W4246670274 title "The Effect of Combining Coronary Bypass With Carotid Endarterectomy in Patients With Unrevascularized Severe Coronary Disease" @default.
• W4246670274 doi "https://doi.org/10.1016/j.jvs.2018.06.076" @default.
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