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Death and adverse cardiac events after carotid endarterectomy
D J Musser1, G G Nicholas, J F Reed
1Department of Surgery, Lehigh Valley Hospital, Allentown, PA 18105.
Insights
Carotid endarterectomy has low operative mortality (1.6%) and stroke rates (0.7%). Preoperative cardiac risk assessment using Goldman criteria identifies high-risk patients for adverse events.
Area of Science:
- Vascular Surgery
- Cardiology
- Outcome Research
Background:
- Carotid endarterectomy is a common procedure to prevent stroke.
- Assessing perioperative cardiac risk is crucial for patient safety.
Purpose of the Study:
- Evaluate operative mortality and adverse cardiac events after carotid endarterectomy.
- Assess the efficacy of preoperative cardiac evaluation.
- Determine stroke mortality rates.
Main Methods:
- Retrospective review of 562 patients undergoing carotid endarterectomy.
- Analysis using chi-squared, logistic regression, and Goldman cardiac risk criteria.
Main Results:
- Operative mortality was 1.6%; myocardial infarction rate was 1.8%.
- Goldman criteria identified high-risk patients (classes III-IV) with a 9.4% mortality rate.
- Stroke rate was 0.7%; combined stroke mortality was 2.3%.
Conclusions:
- Independent clinical variables predict perioperative myocardial infarction and operative death.
- Patients in Goldman classes III and IV face increased risks.
- Carotid surgery is deemed safe in this community setting.
Purpose:
This study evaluated operative mortality rate and adverse cardiac events after carotid endarterectomy. Efficacy of preoperative cardiac evaluation was studied and stroke mortality rate was determined.
Methods:
This was a retrospective review of 562 patients undergoing carotid endarterectomy at a 740-bed community hospital. Data were analyzed with chi 2 analysis, logistic regression analysis, and Goldman criteria for cardiac risk.
Results:
The mortality rate was 1.6% (nine patients). There were 10 myocardial infarctions (1.8%). Six of these (1.1%) were fatal. The Goldman Index allowed us to classify 530 patients in a low-risk group (Goldman classes I and II, operative mortality rate = 1.1%) and 32 patients in a high-risk group (Goldman classes III and IV, mortality rate = 9.4%). Independent risk variables were identified for myocardial infarction and overall operative death. These variables were then used to develop a probability model for prediction of operative death and adverse cardiac events. The stroke rate in the 562 patients was 0.7% (four patients). For the 345 patients with symptoms, the stroke rate was 0.6% (two patients); for the 217 symptom-free patients, it was 0.9% (two patients). The combined stroke mortality rate was 2.3%. For patients with symptoms, it was 2.9%; for symptom-free patients, it was 1.4%.
Conclusions:
Independent clinical variables can help determine patients at increased risk for perioperative myocardial infarction or operative death. Patients in Goldman classes III and IV are at increased risk for adverse events. Carotid surgery can be performed safely in our medical community.