Preoperative Coronary Stenosis Is a Determinant of Early Vascular Outcome after Carotid Endarterectomy.
10.3988/jcn.2015.11.4.364
- Author:
Jung Hwa KIM
1
;
Sung Hyuk HEO
;
Hyo Jung NAM
;
Hyo Chul YOUN
;
Eui Jong KIM
;
Ji Sung LEE
;
Young Seo KIM
;
Hyun Young KIM
;
Seong Ho KOH
;
Dae Il CHANG
Author Information
1. Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Korea. shheo73@khu.ac.kr
- Publication Type:Original Article
- Keywords:
carotid endarterectomy;
coronary artery disease;
coronary angiography;
risk assessment
- MeSH:
Aluminum Oxide;
Angiography;
Angioplasty;
Asian Continental Ancestry Group;
Coronary Angiography;
Coronary Artery Disease;
Coronary Stenosis*;
Endarterectomy;
Endarterectomy, Carotid*;
Hospital Records;
Humans;
Myocardial Infarction;
Risk Assessment;
Risk Factors;
Stents;
Stroke
- From:Journal of Clinical Neurology
2015;11(4):364-371
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND PURPOSE: The benefit of carotid endarterectomy (CEA) is directly influenced by the risk of perioperative adverse outcomes. However, patient-level risks and predictors including coronary stenosis are rarely evaluated, especially in Asian patients. The aim of this study was to determine the relationship between the vascular risk factors underlying CEA, including coronary stenosis, and postoperative outcome. METHODS: One hundred and fifty-three consecutive CEAs from our hospital records were included in this analysis. All patients underwent coronary computed tomography angiography before CEA. Data were analyzed to determine the vascular outcomes in patients with mild-to-moderate vs. severe coronary stenosis and high vs. standard operative risk, based on the criteria for high operative risk defined in the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial. The vascular outcome was defined as the occurrence of postoperative (< or =30 days) stroke, myocardial infarction (MI), or death. RESULTS: An adverse vascular outcome occurred in 8 of the 153 CEAs, with 6 strokes, 2 MIs, and 3 deaths. The vascular outcome differed significantly between the groups with mild-to-moderate and severe coronary stenosis (p=0.024), but not between the high- and standard-operative-risk groups (stratified according to operative risk as defined in the SAPPHIRE trial). Multivariable analysis adjusting for potent predictors revealed that severe coronary stenosis (odds ratio, 6.87; 95% confidence interval, 1.20-39.22) was a significant predictor of the early vascular outcome. CONCLUSIONS: Severe coronary stenosis was identified herein as an independent predictor of an adverse early vascular outcome.
