Long-Term Outcome After Carotid Endarterectomy in Patients with Ischemic Heart Disease
Hyo Jung Nam1, Sung Hyuk Heo1, Bum Joon Kim1
1Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Korea.
Insights
Patients with ischemic heart disease (IHD) face worse long-term outcomes after carotid endarterectomy (CEA). Early evaluation and treatment of IHD are crucial for improving survival and reducing major adverse cardiovascular events (MACEs).
Area of Science:
- Cardiovascular Medicine
- Neurosurgery
- Vascular Surgery
Background:
- Carotid endarterectomy (CEA) outcomes are influenced by confounding factors, notably ischemic heart disease (IHD).
- IHD is a significant contributor to perioperative and long-term mortality following CEA.
- This study compares mortality and major adverse cardiovascular events (MACEs) in CEA patients with and without IHD.
Purpose of the Study:
- To investigate the impact of IHD on long-term mortality and MACEs after CEA.
- To identify predictors of early and long-term adverse cardiovascular events in CEA patients.
- To compare outcomes between CEA patients with and without a history of IHD.
Main Methods:
- A cohort of 229 patients undergoing CEA between 2000 and 2011 was analyzed.
- 45 patients had known or probable IHD, defined by specific cardiovascular criteria.
- Long-term outcomes (mortality, MACEs) were tracked via death certificates and interviews until June 2013.
Main Results:
- The mean follow-up period was 49 months.
- Presence of IHD (HR, 1.93) and symptomatic stenosis (HR, 1.72) were significant predictors of long-term MACEs.
- Patients with IHD exhibited significantly lower survival rates and MACE-free survival.
Conclusions:
- Ischemic heart disease and symptomatic stenosis are associated with poor long-term outcomes post-CEA.
- Conventional high-risk surgical factors did not predict poor outcomes in this cohort.
- Pre- and post-operative evaluation and management of IHD are recommended to improve CEA patient outcomes.
Background:
The long-term outcome after carotid endarterectomy (CEA) is determined by many confounding factors. Ischemic heart disease (IHD) is linked to atherosclerotic stroke, and it is an important cause of death during the perioperative and follow-up periods after CEA. We aimed to investigate mortality and long-term major adverse cardiovascular events (MACEs) in patients with IHD compared with patients who do not have IHD.
Methods:
We consecutively enrolled 229 patients who underwent CEA procedures from 2000 to 2011. Of these patients, 45 had known or probable IHD defined by history or medical record of myocardial infarction, stable/unstable angina, previous coronary revascularization such as percutaneous coronary intervention or coronary artery bypass graft, or positive stress test. Long-term outcome was identified by using death certificates from the Korean National Statistical Office and telephone interviews by June 2013. We investigated predictors of early (≤30 days) and long-term mortality and MACEs (stroke, myocardial infarction, and death).
Results:
Mean follow-up period was 49 months. Cox proportional analysis adjusted for potent predictors revealed symptomatic stenosis (hazard ratio, 1.72; 95% confidence interval, 1.02-2.88; P = 0.042) and presence of IHD (hazard ratio, 1.93; 95% confidence interval, 1.09-3.42; P = 0.025) as significant predictors of long-term MACEs. Kaplan-Meier analysis showed a significantly lower rate of survival (P = 0.030) and MACE-free survival (P = 0.003) in the IHD group.
Conclusions:
In this study, a poor long-term outcome was observed in patients with IHD and symptomatic stenosis but not in patients with conventional high-risk factors for surgery. Therefore, appropriate evaluation and treatment of IHD before and after CEA might be helpful for better outcome.
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