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Clinical Impact of Routine Cardiology Consultation Prior to Elective Carotid Endarterectomy in Neurologically
Francesco Squizzato1, Michele Antonello1, Jacopo Taglialavoro1
1Vascular and Endovascular Surgery Division, Padova University, School of Medicine, Padova, Italy.
Insights
Routine cardiology consultation before carotid endarterectomy (CEA) in asymptomatic patients significantly reduces cardiac complications and long-term cardiovascular mortality. This proactive approach optimizes the risk-benefit ratio for CEA procedures.
Area of Science:
- Cardiology
- Vascular Surgery
- Clinical Outcomes
Background:
- Carotid endarterectomy (CEA) is a procedure to prevent stroke in patients with carotid stenosis.
- The role of routine pre-operative cardiology consultation in neurologically asymptomatic patients undergoing CEA is not well-defined.
- Optimizing cardiovascular risk is crucial for improving outcomes after CEA.
Purpose of the Study:
- To evaluate the clinical impact of routine cardiology consultation prior to CEA in asymptomatic patients.
- To assess early and long-term cardiovascular events following CEA.
- To determine if routine cardiology assessment improves the risk-benefit profile of CEA.
Main Methods:
- Retrospective review of 1972 patients undergoing CEA for asymptomatic carotid stenosis (2007-2017).
- Comparison of two groups: selective (2007-2012) versus routine (2012-2017) pre-operative cardiology consultation.
- Analysis of in-hospital mortality, myocardial infarction (MI), heart failure, arrhythmias, stroke, and long-term survival.
Main Results:
- Routine consultation (Group B) was associated with a significant reduction in overall cardiac complications (1.9% vs 3.4%) and MI (0.6% vs 1.6%) compared to selective consultation (Group A).
- Multivariable analysis identified routine cardiology consultation as an independent predictor for reduced MI and overall cardiac complications.
- Long-term analysis showed significantly lower cardiovascular event mortality in the routine consultation group (95.8% vs 92.0% at 5 years).
Conclusions:
- Routine cardiology consultation before elective CEA in asymptomatic patients effectively reduces peri-operative cardiac complications.
- This strategy also lowers long-term mortality from cardiovascular events.
- Implementing routine cardiology consultations can enhance the risk-benefit ratio of CEA for asymptomatic individuals.
Objective:
The aim was to determine the clinical impact of routine cardiology consultation before carotid endarterectomy (CEA) in neurologically asymptomatic patients, in terms of early and long term cardiovascular events.
Methods:
A single centre retrospective review of consecutive patients receiving CEA from 2007 to 2017 for asymptomatic carotid stenosis was performed. Two groups were compared: patients operated on from 2007 to 2012 received a pre-operative cardiology consultation only in selected cases (group A); from 2012 to 2017 patients received a routine pre-operative cardiology consultation (group B). In hospital death, myocardial infarction (MI), heart failure, dysrhythmias, and stroke were compared. A multiple logistic regression was performed to identify predictors of peri-operative complications. Long term overall survival and freedom from fatal cardiovascular events were compared.
Results:
In total, 878 CEAs were performed in group A and 1094 in group B. Patients in group B were more likely to have had a previous coronary intervention (0.5% vs. 5.1%; p < .001), and to be on dual antiplatelet (4.6% vs. 9.5%; p = .001), statin therapy (60.3% vs. 72.4%; p < .001), and a higher number of cardiac drugs (1.77 ± 1.22 vs. 1.92 ± 1.23; p = .01) at the time of CEA. In hospital mortality was 0.1% for both groups (p = 1.0), and there were no significant differences regarding neurological complications (0.8% vs. 0.3%; p = .20); group B had a significant reduction in overall cardiac complications (3.4% vs. 1.9%; p = .05) and MI (1.6% vs. 0.6%; p = .05). Multivariable analysis confirmed that routine cardiology consultation was an independent predictor of MI (odds [OR] ratio 0.61; p = .04) and overall reduction in cardiac complications (OR 0.28; p = .01). At five years, overall survival was similar (84.2% vs. 82.4%; p = .72), but patients in group B had a significantly lower mortality from cardiovascular events (92.0% vs. 95.8%; p = .04).
Conclusion:
Routine cardiology consultation before elective CEA in patients with asymptomatic carotid stenosis reduced peri-operative cardiac complications and long term fatal cardiovascular events. This approach may be considered to maximise the risk/benefit ratio of CEA in asymptomatic patients.
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