The influence of concurrent carotid endarterectomy on coronary bypass: a case-controlled study
John J Ricotta1, L Philipp Wall, Eugene Blackstone
1State University of New York at Stony Brook, Rm. 19-020, Stony Brook, NY 11794, USA.
Insights
Concurrent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) carry higher risks. However, risk-matched analysis shows complications are due to patient factors, not the combined procedure itself.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Vascular Surgery
Background:
- Concurrent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) are associated with increased stroke and death rates compared to isolated CABG.
- The higher complication rate may stem from the combined procedures or from patients having more extensive atherosclerosis.
Purpose of the Study:
- To determine if the increased morbidity and mortality associated with combined CEA-CABG is due to the combined procedures or patient-specific risk factors.
- To compare outcomes of combined CEA-CABG with isolated CABG and a risk-matched cohort.
Main Methods:
- A case-controlled study utilized data from the New York State Cardiac Database (1997-1998).
- Patients undergoing combined CEA-CABG were compared to all isolated CABG patients and a risk-matched cohort of isolated CABG patients.
Main Results:
- The combined CEA-CABG group (744 patients) had higher rates of stroke (5.1% vs 2%), death (4.4% vs 2%), and combined events (8.1% vs 3.7%) than the overall isolated CABG group (35,539 patients).
- After risk-factor matching, no significant differences in stroke (5.1% vs 5%), death (4.4% vs 3.9%), or combined events (8.1% vs 8.5%) were observed between the combined CEA-CABG and the matched isolated CABG cohorts.
Conclusions:
- Increased complications after combined CEA-CABG are comparable to those in a risk-matched cohort of isolated CABG patients.
- The major morbidity associated with combined CEA-CABG is primarily attributable to inherent patient risk factors, not the addition of CEA to CABG.
Background:
Concurrent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) are associated with an increased incidence of stroke and death compared to isolated CABG. It is unclear whether this reflects two concurrent operative procedures or the increased risk in patients with more extensive atherosclerosis.
Methods:
To address this question, a case controlled study was performed using data from the New York State Cardiac Database from 1997 to 1998. Patients who underwent combined CEA-CABG were compared with all isolated CABG patients and a risk-matched cohort of isolated CABG patients.
Results:
The 35,539 isolated CABG patients had fewer postoperative complications than the 744 combined CEA-CABG patients, but also had a lower overall risk profile. The isolated CABG patients had a lower incidence of stroke (2% vs 5.1%), death (2% vs 4.4%), and combined stroke and death (3.7% vs 8.1%) compared with the combined group ( P < .001). After risk-factor matching, no differences in stroke (5% vs 5.1%), death (3.9% vs 4.4%), or combined stroke and death (8.5% vs 8.1%) were observed.
Conclusions:
Although increased complications are reported after CEA-CABG, these do not differ from those of a risk-matched cohort of isolated CABG patients. Thus, the major morbidity of combined CEA-CABG is due to inherent patient risk and not the addition of CEA to CABG.
