DEATH AND ADVERSE CARDIAC EVENTS AFTER CAROTID ENDARTERECTOMY

Purpose: This study evaluated operative mortality rate and adverse car diac events after carotid endarterectomy. Efficacy of preoperative car diac evaluation was studied and stroke mortality rate was determined. Methods: This was a retrospective review of 562 patients undergoing ca rotid endarterectomy at a 740-bed community hospital. Data were analyz ed with chi(2) analysis, logistic regression analysis, and Goldman cri teria for cardiac risk. Results: The mortality rate was 1.6% (nine pat ients). There were 10 myocardial infarctions (1.8%). Six of these (1.1 %) were fatal. The Goldman Index allowed us to classify 530 patients i n a low-risk group (Goldman classes I and II, operative mortality rate = 1.1%) and 32 patients in a high-risk group (Goldman classes III and IV, mortality rate = 9.4%). Independent risk variables were identifie d for myocardial infarction and overall operative death. These variabl es were then used to develop a probability model for prediction of ope rative death and adverse cardiac events. The stroke rate in the 562 pa tients was 0.7% (four patients). For the 345 patients with symptoms, t he stroke rate was 0.6% (two patients); for the 217 symptom-free patie nts, it was 0.9% (two patients). The combined stroke mortality rate wa s 2.3%. For patients with symptoms, it was 2.9%; for symptom-free pati ents, it was 1.4%. Conclusions: Independent clinical variables can hel p determine patients at increased risk for perioperative myocardial in farction or operative death. Patients in Goldman classes III and IV ar e at increased risk for adverse events. Carotid surgery tan be perform ed safely in our medical community.