Influence of carotid injury in post-myocardial revascularization surgery and its late evolution
Insights
Carotid disease significantly elevates stroke risk in myocardial revascularization surgery (MRS) patients. However, perioperative carotid intervention did not reduce the primary outcome of stroke, TIA, or death.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Medicine
Background:
- Approximately 30% of perioperative cerebrovascular accidents (CVA) during myocardial revascularization surgery (MRS) stem from carotid injuries.
- Current perioperative interventions have not demonstrably reduced this risk.
Purpose of the Study:
- To evaluate the impact of carotid artery disease and perioperative interventions on outcomes in patients undergoing MRS.
- To assess the association between carotid disease and adverse events such as CVA, transient ischemic attack (TIA), and CVA-related death.
Main Methods:
- An observational, retrospective study of 1169 patients over 69 years old undergoing MRS between 2006 and 2010.
- Carotid ultrasonography was performed pre-MRS; carotid disease was defined as lesions >50%.
- Primary outcome included CVA incidence, TIA, and CVA-related death, with an average follow-up of 49 months.
Main Results:
- The prevalence of carotid disease was 19.9%. Patients with carotid disease had a higher incidence of the primary outcome (6.5% vs. 3.7%, p=0.0018).
- Carotid disease was associated with renal dysfunction and peripheral arterial disease. Previous TIA and renal dysfunction were associated with the primary outcome.
- In patients with >70% carotid lesions, perioperative intervention showed a trend towards higher primary outcome incidence (16%) compared to conservative treatment (4.3%, p=0.056).
Conclusions:
- Carotid artery disease is a significant risk factor for CVA, TIA, or CVA-related death in patients undergoing MRS.
- Perioperative carotid intervention did not demonstrate a reduction in the primary composite outcome in this study population.
Background:
Approximately 30% of perioperative CVA of myocardial revascularization surgery (MRS) are a result of carotid injuries, without reduction of risk confirmed by perioperative intervention.
Objectives:
Evaluate the impact of carotid disease and perioperative intervention in patients subjected to MRS.
Methods:
Observational, retrospective study, evaluating 1169 patients aged > 69 years undergoing MRS from January, 2006 and December, 2010, monitored, on average, for 49 months. All patients were subjected to ultrasonography of carotids before MRS. It was defined as carotid disease when lesion > 50%. The primary outcome was composed of CVA incidence, transitory ischemic accident (TIA) and death due CVA.
Results:
Prevalence of carotid disease was of 19.9% of patients. The incidence of primary outcome between unhealthy and healthy patients was of 6.5% and 3.7%, respectively (p = 0.0018). In the first 30 days, there were 18.2% of events. Were related to carotid disease: renal dysfunction (OR 2.03, IC95% 1.34-3.07; p < 0.01), peripheral arterial disease (OR 1.80, IC95% 1.22-2.65; p < 0.01) and previous myocardial infarction (OR 0.47, IC95% 0.35-0.65; p < 0.01). Regarding the primary outcome, were associated the previous TIA (OR 5.66, IC95% 1.67-6.35; p < 0.01) and renal dysfunction (OR 3.28, IC95% 1.67-6.45; p < 0.01). In patients with lesion >70%, perioperative carotid intervention demonstrated an incidence of 16% in primary outcome compared to 4.3% in conservatory treatment (p = 0.056) with no difference between percutaneous and surgical approaches (p = 0.516).
Conclusion:
Carotid disease increases the risk of CVA, TIA or death due to CVA in MRS. However, the carotid intervention was not related to reduction of primary outcome.
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