Coronary and carotid operations under prospective standardized conditions:Incidence and outcome

Background. No randomized trial has yet evaluated the hypothetical benefit of carotid endarterectomy with coronary artery bypass grafting. This prospe ctive review was undertaken to determine the differences between observed a nd predicted complication rates, as well as to define new predictors and as sess costs in a standardized population. Methods. A prospective nonrandomized study was undertaken over a 4-year per iod involving all coronary artery bypass graftings done at one institution. Operative procedure was standardized. All patients underwent preoperative screening for carotid disease. If 80% or more stenosis was present, combine d coronary artery bypass grafting and carotid endarterectomy was performed. Results. Of 2,071 patients, 1,987 had coronary artery bypass grafting only. In that group there were 34 strokes (1.7%) and 41 deaths (2.0%). Eighty-fo ur patients underwent combined coronary artery bypass grafting/carotid enda rterectomy and in that group there were four strokes (4.7%) and five deaths (5.9%). Independent risk factors for postoperative stroke were age (odds r atio 1.09; 95% confidence interval 1.04, 1.3), hypertension (odds ratio 2.6 7; 95% confidence interval 1.22 5.23), extensively calcified aorta (odds ra tio 2.82; 95% confidence interval 1.34, 5.97), and bypass time (odds ratio 1.01; 95% confidence interval 1.00, 1.02). Cast of a stroke was significant (p < 0.05) in both groups. Conclusions. Patients with carotid disease fall into a higher risk group th an patients without it. This increased risk is not because of carotid disea se alone. Patients without significant carotid disease, who suffered a peri operative stroke, fell into an even higher risk category. Furthermore, caro tid endarterectomy was not a significant risk factor by either the univaria te or the multivariate analysis. (C) 2000 by The Society of Thoracic Surgeo ns.