Life-threatening coronary disease is prevalent in patients with stenosing carotid artery disease
Krista Nuotio1,2, Lauri Soinne2, Helena Hänninen3
1Molecular Neurology, Research Programs Unit, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland.
Insights
Patients undergoing carotid endarterectomy face a high risk of death and myocardial infarction. Intensified cardiovascular disease-risk-lowering treatment is crucial for these high-risk individuals.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Epidemiology
Background:
- Atherosclerosis impacts multiple vascular systems, necessitating interventions like carotid endarterectomy for stroke risk reduction.
- Despite carotid plaque removal, patients remain susceptible to atherothrombotic events such as myocardial infarction and premature death.
Purpose of the Study:
- To determine the long-term incidence of mortality and atherothrombotic events after carotid endarterectomy.
- To identify risk factors associated with adverse outcomes in this patient population.
Main Methods:
- A cohort of 89 patients who underwent carotid endarterectomy between 1997-2000 were followed for up to 15.2 years.
- Data on mortality, cardiovascular events (stroke, TIA, MI), comorbidities, and medications were collected.
- Cox regression analysis and age/gender-matched comparisons with population controls were employed.
Main Results:
- 44.6% of patients died during follow-up, with 24.4% of deaths attributed to acute myocardial infarction.
- High risks of death were observed in diabetics (5.7-fold) and smokers (3.9-fold).
- Lack of statin use significantly increased the risk of death (5.0-fold) and acute myocardial infarction (4.4-fold).
Conclusions:
- Carotid endarterectomy patients exhibit elevated risks of acute myocardial infarction and mortality.
- Intensified cardiovascular disease risk management, including statin therapy and evaluation for myocardial ischemia, is recommended.
- Further clinical trials are warranted to explore early intervention benefits for these high-risk patients.
Background:
Atherosclerosis affects several vascular trees systemically and though surgical plaque removal diminishes the risk of stroke in patients with carotid stenosis, they still face a risk of other atherothrombotic complications like myocardial infarction and premature death.
Aims And/Or Hypothesis:
This study was designed to reveal the long-term risk of death and atherothrombotic events following carotid endarterectomy.
Methods:
Eighty-nine previously (1997-2000) endarterectomized carotid patients (56-92 years) were followed up to 15·2 years. Causes of death, cardiovascular events (stroke, transient ischemic attack, acute myocardial infarction), comorbidities, and medications were recorded and analyzed by Cox regression analysis. Four population controls and four controls with coronary disease (n = 712) were selected for each case from a population cohort for age- and gender-matched analysis.
Results:
At the end of follow-up, 41 (44·6%) patients had died and 48 were alive. Ten patients (24,4%) died due to acute myocardial infarction and one (2,4%) due to stroke. Nineteen (21%) patients had an acute myocardial infarction, 12 (13%) had a stroke, 13 (15%) had a transient ischemic attack, and 5 (6%) had other atherothrombotic events. The risk of death was 5·7-fold in diabetics (P < 0·001) and 3·9-fold in smokers (P < 0·001). Patients who did not use statins had 5·0-fold, and irregular users 3·3-fold risk of death compared with active users (P = 0·005 and P = 0·001, respectively). The major factors associated with acute myocardial infarction were diabetes (6·0-fold risk, P = 0·004), bilateral carotid disease (3·5-fold risk, P = 0·014), and lack of statin use (4·4-fold risk, P = 0·038). Compared with population controls, carotid patients had a 4·4-fold risk of acute myocardial infarction (P = 0·002).
Conclusions:
Endarterectomized carotid patients have a high risk of acute myocardial infarction and death, and need an intensified cardiovascular disease-risk-lowering treatment. Although asymptomatic, the evaluation of prognostically significant myocardial ischemia should be considered in these high-risk patients. Eventually, a clinical trial is needed to address whether carotid patients would benefit from early intervention.
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