title: Cardiac events after combined surgery for coronary and carotid artery disease.
abstract: OBJECTIVE
  To evaluate serious cardiac events after combined (either single or two stage) coronary artery surgery (CAS) and carotid endarterectomy (CEA) for concomitant coronary and carotid artery disease.
  
  
  METHODS
  We have analyzed our 15 year experience (January 1981-September 1996) with 201 consecutive patients operated on using both approaches. Group A consisted of 48 patients with the single-stage procedure, while in group B (153 patients), two stage procedure was carried out, either as carotid endarterectomy (CEA), followed by coronary artery bypass surgery (CAS) (group B1- 103 patients), or as CAS followed by CEA (group B2- 50 patients). Five patients from B1 group died after the CEA procedure, but were included, despite the fact they never reached the second stage. Left main coronary artery disease was found in 41 patients (20.4%), poor left ventricular function in 49 (24.4%) previous MI in 133 (66.2%), while 136 (67.7%) were in NYHA functional class III or IV. Bilateral carotid involvement was present in 61 patients (30.3%). Unstable angina was more prevalent in groups A and B2 (P < 0.0001). NYHA class III/IV in group A (versus B1, P = 0.001 and versus B2, P = 0.02), low ejection fraction in groups A and B2 (P < 0.0001), bilateral carotid stenosis in group B1 (versus A, P = 0.003 and versus B2, P < 0.0001), and ulcerated plaque in group B1 (P < 0.0001). These differences dictated the surgical strategy, which resulted in different protocols for clinical and operative management.
  
  
  RESULTS
  Early mortality for the entire group was 5.5% (11/201) 6.2% in group A, 7.8% in group B1 and 0% in group B2, respectively; (P > 0.05). Serious morbidity occurred in 7.5% of patients (8.3% in group A, 7.8% in group B1 and 6% in group B2, respectively; P > 0.05). Univariate analysis revealed only bilateral carotid stenosis to influence early outcome (P = 0.04).
  
  
  CONCLUSIONS
  Patients with concomitant coronary and carotid artery disease have relatively good immediate operative results, providing all existing lesions are corrected. Despite it did not reach the statistical significance, cardiac events were less frequent in groups A and B2 indicating possible protective effect of prior CAS in patients with concomitant disease.
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute (Institut za kardiovaskularne bolesti Dedinje), Belgrade, Yugoslavia.
authors.forename: M
authors.initials: M
authors.lastname: Perić
authors.forename: R
authors.initials: R
authors.lastname: Huskić
authors.forename: D
authors.initials: D
authors.lastname: Nezić
authors.forename: S
authors.initials: S
authors.lastname: Nastasić
authors.forename: Z
authors.initials: Z
authors.lastname: Popović
authors.forename: B
authors.initials: B
authors.lastname: Radević
authors.forename: A D
authors.initials: AD
authors.lastname: Popović
authors.forename: M
authors.initials: M
authors.lastname: Bojić
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000150:complications* / Q000601:surgery*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D016016:Proportional Hazards Models