Key result
Selective coronary angiography before carotid endarterectomy is linked to a ~3% postoperative MI rate.
Why the study?
The impact of coronary artery disease on outcomes after carotid endarterectomy and the role of selective coronary arteriography and CABG based on clinical criteria were evaluated.
Does a selective approach to coronary arteriography and CABG based on clinical criteria result in acceptable mortality and cardiac morbidity in patients undergoing carotid endarterectomy?
Cohort (n=531)
Does a selective approach to coronary arteriography and CABG based on clinical criteria result in acceptable mortality and cardiac morbidity in patients undergoing carotid endarterectomy?
A selective approach to coronary evaluation and CABG based on clinical criteria in patients undergoing carotid endarterectomy is associated with low mortality and cardiac morbidity.
Answers are grounded in this paper and cite their sources.
Clinical criteria may suffice for preoperative cardiac risk assessment in vascular surgery; leaves open whether routine invasive testing improves outcomes.
In a series of 531 CENDX, preoperative cardiac risk was categorized by clinical criteria. Patients with CAD (history of previous MI, angina, congestive heart failure, and/or electrocardiographic evidence of CAD were selected for more invasive studies based on clinical criteria. The overall incidence of postoperative myocardial infarction was 2.5% and increased slightly to 4% in patients with symptomatic cardiac disease. More importantly, the overall mortality was 0.9% and only 3 of 13 (23%) postoperative myocardial infarctions were fatal. Neurologic complications averaged 1.4% and approximately 70% were related to preceding cardiac events. Twenty-two patients or 4% of the entire series underwent carotid endarterectomy combined with coronary artery bypass graft and this approach was associated with one death and one stroke. Therefore, we conclude that a selective approach to coronary arteriography and subsequent CABG based on clinical criteria is associated with an acceptably low mortality and cardiac morbidity.
No takes yet. Share an insight, caveat, or question.
O’Donnell et al. (1983) conducted a cohort in Carotid artery disease requiring endarterectomy (n=531). Selective approach to coronary arteriography and CABG was evaluated on Postoperative myocardial infarction. A selective approach to coronary arteriography and CABG based on clinical criteria in patients undergoing carotid endarterectomy was associated with a 2.5% rate of postoperative MI and 0.9% overall mortality.
Synapse has enriched 10 related papers. Consider them for comparative context: