What question did this study set out to answer?

To evaluate the incidence of perioperative myocardial infarction and early survival following carotid endarterectomy using routine clinical evaluation for coronary arterial disease.

October 1, 1989Archives of Surgery

Analysis of Risk Factors for Myocardial Infarction Following Carotid Endarterectomy

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Carotid artery disease requiring endarterectomy (n=224). Intervention: Routine clinical evaluation for coronary arterial disease prior to carotid endarterectomy. Primary outcome: Perioperative (30-day) myocardial infarction.

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Key result

Routine clinical evaluation for coronary artery disease prior to carotid endarterectomy was associated with a low rate of perioperative myocardial infarction (0.4% fatal, 3.6% nonfatal).

Why the study?

Is routine clinical evaluation for coronary arterial disease sufficient to predict and manage perioperative myocardial infarction risk in patients undergoing carotid endarterectomy?

Population

224 patients undergoing 249 consecutive carotid endarterectomies, 73% with evidence of coronary arterial…

Design

Cohort

Follow-up

mean 21 months

Authors

RYRichard A. YeagerOregon Health & Science University

Discussion

Member takes

Implication

May support limiting preoperative cardiac testing to clinical evaluation before carotid endarterectomy; hypothesis-generating pending randomized confirmation.

Key Points

To evaluate the incidence of perioperative myocardial infarction and early survival following carotid endarterectomy using routine clinical evaluation for coronary arterial disease.
Reviewed 249 consecutive carotid endarterectomies performed on 224 patients over a 4-year period with a mean follow-up of 21 months.
Assessed coronary arterial disease via routine medical history, physical examination, and electrocardiogram, reserving further invasive workups only for unstable angina.
Optimized and stabilized coronary symptoms medically prior to surgical intervention.
Evidence of coronary arterial disease was identified preoperatively in 73% of patients.
Perioperative myocardial infarction occurred in 10 cases (4.0%), consisting of 1 fatal event (0.4%) and 9 nonfatal events (3.6%) within 30 days.
Early survival in medically stabilized patients with active coronary symptoms who did not receive coronary bypass was comparable to those undergoing preceding or subsequent bypass.

Study Design

Type

Cohort (n=224)

Structured PICO

Is routine clinical evaluation for coronary arterial disease sufficient to predict and manage perioperative myocardial infarction risk in patients undergoing carotid endarterectomy?

Population

224 consecutive patients undergoing 249 carotid endarterectomies, with 73% having evidence of coronary arterial disease, followed for a mean of 21 months.

Exposure

Routine clinical evaluation for coronary arterial disease (history, physical examination, and electrocardiogram) prior to carotid endarterectomy.

Outcome

Incidence of perioperative (30-day) myocardial infarction and early survivalhard clinical

Routine clinical evaluation (history, physical, ECG) appears sufficient for preoperative cardiac risk assessment prior to carotid endarterectomy, without the need for aggressive screening like coronary arteriography.

Cite This Study

Richard A. Yeager (1989) conducted a cohort in Carotid artery disease requiring endarterectomy (n=224). Routine clinical evaluation for coronary arterial disease prior to carotid endarterectomy was evaluated on Perioperative (30-day) myocardial infarction. Routine clinical evaluation for coronary artery disease prior to carotid endarterectomy was associated with a low rate of perioperative myocardial infarction (0.4% fatal, 3.6% nonfatal).

synapsesocial.com/papers/6a8db40d3974254b714ac44e https://doi.org/10.1001/archsurg.1989.01410100040008

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Implication

May support limiting preoperative cardiac testing to clinical evaluation before carotid endarterectomy; hypothesis-generating pending randomized confirmation.

Analysis of Risk Factors for Myocardial Infarction Following Carotid Endarterectomy

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Analysis of Risk Factors for Myocardial Infarction Following Carotid Endarterectomy

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

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