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Cardiac risk in patients undergoing carotid endarterectomy: impact on perioperative and long-term mortality
W C Mackey1, T F O'Donnell, A D Callow
1New England Medical Center, Tufts University Department of Surgery, Boston, MA.
Insights
Patients with overt coronary disease undergoing carotid endarterectomy face higher cardiac event risks. Those without overt disease but with risk factors have reduced long-term survival compared to those without risk factors.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Surgery
Background:
- Carotid endarterectomy is a common procedure for stroke prevention.
- Identifying patients at high risk for cardiac events post-surgery is crucial for improved outcomes.
Purpose of the Study:
- To identify patients undergoing carotid endarterectomy at high risk for cardiac events and death.
- To stratify survival based on the presence of overt coronary disease and risk factors.
Main Methods:
- A cohort of 614 patients undergoing carotid endarterectomy was studied.
- Patients were categorized into groups based on overt coronary disease and coronary risk factors (diabetes, hyperlipidemia, smoking).
- Life-table survival analysis was performed at 30-day, 5-, 10-, and 15-year intervals.
Main Results:
- Overt coronary disease significantly diminished both 30-day (p=0.03) and late (p<0.0001) survival.
- Patients without overt coronary disease but with risk factors showed similar early survival but reduced late survival compared to those without risk factors.
- Myocardial infarction was the primary cause of death across all patient groups.
Conclusions:
- Overt coronary disease is a strong predictor of high risk for late cardiac events and mortality after carotid endarterectomy.
- Patients without overt coronary disease have a better prognosis, with those lacking risk factors exhibiting the best long-term survival.
- Risk stratification is essential for managing patients undergoing carotid endarterectomy.
Abstract:
To identify patients undergoing carotid endarterectomy who are at high risk for cardiac events and death, we studied the course of 614 patients with known risk factors who were entered into our carotid follow-up registry. Patients were divided into two groups, group I with overt coronary disease (prior myocardial infarction, angina, significant electrocardiographic abnormalities) (N = 324) and group II without overt coronary disease (N = 290). Group II patients were subdivided into groups with (IIA) (N = 206) and without (IIB) (N = 84) coronary risk factors (cigarettes, diabetes, or hyperlipidemias). Thirty-day, 5-, 10-, and 15-year life-table survival for the groups was: I = 98.5%, 68.6%, 44.9%, 36.4%, respectively; II = 100%, 86.4%, 72.3%, 54.3%, respectively; IIA = 100%, 84.8%, 66.9%, 41.5%, respectively; IIB = 100%, 90.5%, 87.9%, 87.9%, respectively. Overt coronary disease was associated with diminished 30-day (p = 0.03) and late (p less than 0.0001) survival. Risk factors in the absence of overt disease were not associated with diminished 30-day survival. Late survival up to 3 years from endarterectomy was similar in groups IIA and IIB, but later survival was diminished in group IIA. Myocardial infarction was the most frequent cause of death in all groups. Patients with overt coronary disease are at high risk for late cardiac events and death. Patients without overt disease are at less risk than those with overt disease, and in the absence of overt disease, those without are at less risk than those with risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)