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Prediction of coronary artery disease in patients undergoing carotid endarterectomy
Toshifumi Shimada1, Kazunori Toyoda, Tooru Inoue
1Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan.
Insights
Peripheral artery disease and diabetes mellitus predict coronary artery disease in patients undergoing carotid endarterectomy. Careful screening for coronary artery disease is crucial, especially in those with multiple risk factors.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
Background:
- Coronary artery disease (CAD) is a significant concern in patients undergoing carotid endarterectomy (CEA).
- Identifying predictors of concomitant CAD is essential for comprehensive patient management.
Purpose of the Study:
- To determine factors predicting the presence and severity of coronary artery disease (CAD) in patients undergoing carotid endarterectomy (CEA).
Main Methods:
- Retrospective analysis of 200 Japanese patients undergoing CEA for extracranial carotid artery stenosis.
- Statistical analysis to identify independent predictors of CAD and severe CAD using odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- Peripheral artery disease (PAD) was an independent predictor of CAD (OR 2.61).
- Diabetes mellitus (DM) (OR 2.8) and PAD (OR 2.83) independently predicted severe CAD.
- DM was an independent predictor of occult CAD (OR 4.83), with 25% of CAD cases detected pre-CEA being asymptomatic.
Conclusions:
- Patients with DM, PAD, or multiple coronary risk factors scheduled for CEA require thorough screening for concomitant CAD, particularly severe forms.
- Even in the absence of angina symptoms, the presence of risk factors necessitates careful evaluation for underlying coronary artery disease.
Object:
The authors determined the factors that predict the coexistence of coronary artery disease (CAD) in patients who undergo carotid endarterectomy (CEA).
Methods:
Data from 200 consecutive Japanese patients who underwent CEA for extracranial carotid artery stenosis were studied. Among 73 patients with CAD, 35 (48%) had three-vessel or left main CAD (that is, severe CAD). Peripheral artery disease was an independent predictor of CAD (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.08-6.3). In addition, diabetes mellitus ([DM]; OR 2.8, 95% CI 1.24-6.32) and peripheral artery disease (PAD) (OR 2.83, 95% CI 1.05-7.57) were independent predictors of severe CAD in the 200 patients. The percentage of patients with CAD as well as those with the severe form of the disease increased stepwise as the number of major coronary risk factors in patients increased. Asymptomatic CAD was newly detected during the pre-CEA assessment in 18 (25%) of the 73 patients in whom CAD was eventually diagnosed. Diabetes mellitus was an independent predictor of occult CAD among the 200 patients (OR 4.83, 95% CI 1.53-15.2).
Conclusions:
In patients with DM, PAD, or multiple major coronary risk factors who have been scheduled for CEA, one should carefully search for concomitant CAD, especially severe CAD, even when the patient has had no previous episode of angina.
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