Abstract 2295: Current Outcomes of Simultaneous Carotid Endarterectomy and Coronary Artery Bypass in North America
OBJECTIVE: Management of patients with concomitant carotid and coronary artery disease has been controversial. Divergent strategies have been employed, including simultaneous carotid endarterectomy and coronary bypass (SCC) versus various staged procedures. While no strict comparison group is available, this study defines current outcomes of SCC, as compared qualitatively to two reference categories.
METHODS: Utilizing the STS database from 2003 to 2007, patients having SCC were compared to cerebrovascular disease patients undergoing coronary bypass with prior carotid endarterectomy (Ref Gp I), and those with carotid Doppler stenosis >75% and no carotid intervention (Ref Gp II). Logistic regression analysis adjusted for differences in baseline characteristics, and operative mortality (OM) and a composite of neurological complications (NC) were assessed.
RESULTS: Of 747,932 patients undergoing isolated CABG with/without CEA, 108,271 (14.4 %) had cerebrovascular disease. In this group, 5,732 (5.3%) underwent SCC. The SCC group had more males and less severe coronary disease (both p<0.001). After statistical adjustment for all baseline differences, SCC had clinically and statistically higher OM and NC as compared to any of the reference groups (TABLE⇓).
CONCLUSION: Although no proper control group exists for comparison, SCC as recently performed in North America carries a high risk, as compared to any of the reference groups. Suboptimal results associated with the SCC strategy suggest a need for quality improvement and research on the optimal management of patients with simultaneous carotid and coronary disease.