ESCVS article - Coronary

Early and late results of combined carotid endarterectomy and coronary artery bypass versus isolated coronary artery bypass

Lois Nwakanma, Hataya Kristy Poonyagariyagorn, Ricardo Bello, Ali Khoynezhad, Douglas Smego, Konstadinos A. Plestis

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: Optimal management of patients with combined coronary and carotid artery disease remains controversial. This study analyzed the outcomes between simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) vs. isolated CABG. Methods: We reviewed the early and late follow-up data of 412 patients who underwent either combined CEA/CABG vs. CABG alone between August 1999 and October 2003. All patients undergoing CEA had at least 80% stenosis of one carotid artery. Data were obtained for pre-, intra-, and early postoperative variables. Late follow-up data (range 1.1 to 69.5 months postoperative, mean 42.4 months, median 42.7 months) included myocardial infarctions (MI), stroke and death. Differences between the two groups were investigated. Univariate and multivariate analysis were carried out to identify predictors of death, MI, and stroke in the entire group. Results: There were 27 patients (6.6%) in the CEA/CABG group and 385 patients in the CABG alone group. There was one patient (3.7%) in the CEA/CABG group who had a perioperative stroke versus six (1.6%) in the CABG group (P=0.38). There were no documented postoperative myocardial infarctions (MI) by EKG and CK-MB criteria in both groups. There were no deaths in the CEA/CABG group versus three in the CABG group (P=1.00). Within the follow-up period, strokes developed in 2 (7.4%) CEA/CABG patients and in 7 (2.3%) CABG patients (P=0.16). Three CEA/CABG patients (11.1%) developed MI versus 19 (6.1%) patients in the CABG group (P=0.40). There were 4 (14.8%) deaths in the CEA/CABG group versus 51 (13.4%) in the CABG group (P=0.77). Freedom from death, stroke, and myocardial infarction was not statistically different between the groups at 60 months (all P>0.05). Conclusions: The addition of CEA to CABG did not increase short- and long-term morbidity and mortality compared to isolated CABG in our group of patients. Combined CEA/CABG can be performed safely in this high-risk group of patients. Prospective randomized study is needed to further substantiate these findings.

Original languageEnglish (US)
Pages (from-to)159-165
Number of pages7
JournalInteractive Cardiovascular and Thoracic Surgery
Volume5
Issue number2
DOIs
StatePublished - Apr 1 2006

Fingerprint

Carotid Endarterectomy
Carotid Arteries
Coronary Artery Bypass
Stroke
Myocardial Infarction
Carotid Artery Diseases
Carotid Stenosis

Keywords

  • Carotid endarterectomy
  • Carotid stenosis
  • Combined coronary artery bypass and carotid endarterectomy
  • Coronary artery bypass
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

ESCVS article - Coronary : Early and late results of combined carotid endarterectomy and coronary artery bypass versus isolated coronary artery bypass. / Nwakanma, Lois; Poonyagariyagorn, Hataya Kristy; Bello, Ricardo; Khoynezhad, Ali; Smego, Douglas; Plestis, Konstadinos A.

In: Interactive Cardiovascular and Thoracic Surgery, Vol. 5, No. 2, 01.04.2006, p. 159-165.

Research output: Contribution to journalArticle

Nwakanma, Lois ; Poonyagariyagorn, Hataya Kristy ; Bello, Ricardo ; Khoynezhad, Ali ; Smego, Douglas ; Plestis, Konstadinos A. / ESCVS article - Coronary : Early and late results of combined carotid endarterectomy and coronary artery bypass versus isolated coronary artery bypass. In: Interactive Cardiovascular and Thoracic Surgery. 2006 ; Vol. 5, No. 2. pp. 159-165.
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abstract = "Objective: Optimal management of patients with combined coronary and carotid artery disease remains controversial. This study analyzed the outcomes between simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) vs. isolated CABG. Methods: We reviewed the early and late follow-up data of 412 patients who underwent either combined CEA/CABG vs. CABG alone between August 1999 and October 2003. All patients undergoing CEA had at least 80{\%} stenosis of one carotid artery. Data were obtained for pre-, intra-, and early postoperative variables. Late follow-up data (range 1.1 to 69.5 months postoperative, mean 42.4 months, median 42.7 months) included myocardial infarctions (MI), stroke and death. Differences between the two groups were investigated. Univariate and multivariate analysis were carried out to identify predictors of death, MI, and stroke in the entire group. Results: There were 27 patients (6.6{\%}) in the CEA/CABG group and 385 patients in the CABG alone group. There was one patient (3.7{\%}) in the CEA/CABG group who had a perioperative stroke versus six (1.6{\%}) in the CABG group (P=0.38). There were no documented postoperative myocardial infarctions (MI) by EKG and CK-MB criteria in both groups. There were no deaths in the CEA/CABG group versus three in the CABG group (P=1.00). Within the follow-up period, strokes developed in 2 (7.4{\%}) CEA/CABG patients and in 7 (2.3{\%}) CABG patients (P=0.16). Three CEA/CABG patients (11.1{\%}) developed MI versus 19 (6.1{\%}) patients in the CABG group (P=0.40). There were 4 (14.8{\%}) deaths in the CEA/CABG group versus 51 (13.4{\%}) in the CABG group (P=0.77). Freedom from death, stroke, and myocardial infarction was not statistically different between the groups at 60 months (all P>0.05). Conclusions: The addition of CEA to CABG did not increase short- and long-term morbidity and mortality compared to isolated CABG in our group of patients. Combined CEA/CABG can be performed safely in this high-risk group of patients. Prospective randomized study is needed to further substantiate these findings.",
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AU - Bello, Ricardo

AU - Khoynezhad, Ali

AU - Smego, Douglas

AU - Plestis, Konstadinos A.

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N2 - Objective: Optimal management of patients with combined coronary and carotid artery disease remains controversial. This study analyzed the outcomes between simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) vs. isolated CABG. Methods: We reviewed the early and late follow-up data of 412 patients who underwent either combined CEA/CABG vs. CABG alone between August 1999 and October 2003. All patients undergoing CEA had at least 80% stenosis of one carotid artery. Data were obtained for pre-, intra-, and early postoperative variables. Late follow-up data (range 1.1 to 69.5 months postoperative, mean 42.4 months, median 42.7 months) included myocardial infarctions (MI), stroke and death. Differences between the two groups were investigated. Univariate and multivariate analysis were carried out to identify predictors of death, MI, and stroke in the entire group. Results: There were 27 patients (6.6%) in the CEA/CABG group and 385 patients in the CABG alone group. There was one patient (3.7%) in the CEA/CABG group who had a perioperative stroke versus six (1.6%) in the CABG group (P=0.38). There were no documented postoperative myocardial infarctions (MI) by EKG and CK-MB criteria in both groups. There were no deaths in the CEA/CABG group versus three in the CABG group (P=1.00). Within the follow-up period, strokes developed in 2 (7.4%) CEA/CABG patients and in 7 (2.3%) CABG patients (P=0.16). Three CEA/CABG patients (11.1%) developed MI versus 19 (6.1%) patients in the CABG group (P=0.40). There were 4 (14.8%) deaths in the CEA/CABG group versus 51 (13.4%) in the CABG group (P=0.77). Freedom from death, stroke, and myocardial infarction was not statistically different between the groups at 60 months (all P>0.05). Conclusions: The addition of CEA to CABG did not increase short- and long-term morbidity and mortality compared to isolated CABG in our group of patients. Combined CEA/CABG can be performed safely in this high-risk group of patients. Prospective randomized study is needed to further substantiate these findings.

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KW - Carotid stenosis

KW - Combined coronary artery bypass and carotid endarterectomy

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KW - Stroke

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