Concomitant carotid endarterectomy and cardiac surgery does not decrease postoperative stroke rates

• Published in: Journal of vascular surgery 2020-08, Vol.72 (2), p.589-596.e3
• Main Authors: Klarin, Derek, MD, Patel, Virendra I., MD, MPH, Zhang, Shuaiqi, MS, Xian, Ying, MD, PhD, Kosinski, Andrzej, PhD, Yerokun, Babatunde, MD, Badhwar, Vinay, MD, Thourani, Vinod H., MD, Sundt, Thoralf M., MD, Shahian, David, MD, Melnitchouk, Serguei, MD
• Format: Article
• Language: English
• Subjects: Adult; CABG; Cardiopulmonary bypass; Carotid endarterectomy; Coronary artery disease; Surgery
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2019.10.072

AbstractObjectiveThe timing of operative revascularization for patients with concomitant carotid artery stenosis and coronary artery disease remains controversial. We examined the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database to evaluate the association of combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) with postoperative outcomes. MethodsAll patients undergoing CABG with known carotid stenosis of >80% were identified from 2011 to 2016. Individuals were stratified by use of cardiopulmonary bypass and whether a concomitant CEA was performed at the time of CABG. Multivariate logistic regression was used to model the probability of combined CABG and CEA. The resulting propensity scores were used to match individuals on the basis of clinical and operative characteristics to evaluate primary (30-day mortality and in-hospital transient ischemic attack and stroke) and secondary (STS morbidity composite events and length of stay) end points, with P < .05 required to declare statistical significance. ResultsAfter propensity score matching, 994 off-pump CABG patients (497 CABG only and 497 CABG-CEA) and 5952 on-pump CABG patients (2976 CABG only and 2976 CABG-CEA) were identified. For patients who received on-pump operations, those undergoing CABG-CEA had no observed difference in rate of in-hospital stroke (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.72-1.21; P = .6), higher incidence of STS morbidity composite events (OR, 1.15, 95% CI, 1.01-1.31; P = .03), longer length of stay (7.0 [interquartile range, 5.0-9.0] days vs 6.0 [interquartile range, 5.0-9.0] days; P