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

Publication ,  Journal Article
Klarin, D; Patel, VI; Zhang, S; Xian, Y; Kosinski, A; Yerokun, B; Badhwar, V; Thourani, VH; Sundt, TM; Shahian, D; Melnitchouk, S
Published in: J Vasc Surg
August 2020

OBJECTIVE: The 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. METHODS: All 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. RESULTS: After 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 < .005), and no observed difference in 30-day mortality (OR, 1.28; 95% CI, 0.97-1.69; P = .08) compared with those undergoing CABG only. For off-pump procedures, CABG-CEA patients had no observed difference in rate of in-hospital stroke (OR, 0.80; 95% CI, 0.37-1.69; P = .56) compared with those undergoing CABG only. CONCLUSIONS: Whereas the differences are relatively small, these data suggest that a combined CABG-CEA approach is unlikely to provide significant stroke reduction benefit compared with CABG only. However, comparison with staged approaches merits further investigation.

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Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

August 2020

Volume

72

Issue

2

Start / End Page

589 / 596.e3

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Middle Aged
  • Male
  • Ischemic Attack, Transient
 

Citation

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Klarin, D., Patel, V. I., Zhang, S., Xian, Y., Kosinski, A., Yerokun, B., … Melnitchouk, S. (2020). Concomitant carotid endarterectomy and cardiac surgery does not decrease postoperative stroke rates. J Vasc Surg, 72(2), 589-596.e3. https://doi.org/10.1016/j.jvs.2019.10.072
Klarin, Derek, Virendra I. Patel, Shuaiqi Zhang, Ying Xian, Andrzej Kosinski, Babatunde Yerokun, Vinay Badhwar, et al. “Concomitant carotid endarterectomy and cardiac surgery does not decrease postoperative stroke rates.J Vasc Surg 72, no. 2 (August 2020): 589-596.e3. https://doi.org/10.1016/j.jvs.2019.10.072.
Klarin D, Patel VI, Zhang S, Xian Y, Kosinski A, Yerokun B, et al. Concomitant carotid endarterectomy and cardiac surgery does not decrease postoperative stroke rates. J Vasc Surg. 2020 Aug;72(2):589-596.e3.
Klarin, Derek, et al. “Concomitant carotid endarterectomy and cardiac surgery does not decrease postoperative stroke rates.J Vasc Surg, vol. 72, no. 2, Aug. 2020, pp. 589-596.e3. Pubmed, doi:10.1016/j.jvs.2019.10.072.
Klarin D, Patel VI, Zhang S, Xian Y, Kosinski A, Yerokun B, Badhwar V, Thourani VH, Sundt TM, Shahian D, Melnitchouk S. Concomitant carotid endarterectomy and cardiac surgery does not decrease postoperative stroke rates. J Vasc Surg. 2020 Aug;72(2):589-596.e3.
Journal cover image

Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

August 2020

Volume

72

Issue

2

Start / End Page

589 / 596.e3

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Middle Aged
  • Male
  • Ischemic Attack, Transient