A systematic review of outcomes following staged and synchronous carotid endarterectomy and coronary artery bypass.
OBJECTIVE
to determine the overall cardiovascular risk for patients with combined cardiac and carotid artery disease undergoing synchronous coronary artery bypass (CABG) and carotid endarterectomy (CEA), staged CEA then CABG and reverse staged CABG then CEA.


METHODS
systematic review of 97 published studies following 8972 staged or synchronous operations.


RESULTS
mortality was highest in patients undergoing synchronous CEA+CABG (4.6%, 95% CI 4.1-5.2). Reverse staged procedures (CABG-CEA) were associated with the highest risk of ipsilateral stroke (5.8%, 95% CI 0.0-14.3) and any stroke (6.3%, 95% CI 1.0-11.7). Peri-operative myocardial infarction (MI) was lowest following the reverse staged procedure (0.9%, 95% CI 0.5-1.4) and highest in patients undergoing staged CEA-CABG (6.5%, 95% CI 3.2-9.7). The risk of death+/-any stroke was highest in patients undergoing synchronous CEA+CABG (8.7%, 95% CI 7.7-9.8) and lowest following staged CEA-CABG (6.1%, 95% CI 2.9-9.3). The risk of death/stroke or MI was 11.5% (95% CI 10.1-12.9) following synchronous procedures versus 10.2% (95% CI 7.4-13.1) after staged CEA then CABG.


CONCLUSIONS
10-12% of patients undergoing staged or synchronous procedures suffered death or major cardiovascular morbidity (stroke, MI) within 30 days of surgery. Overall, there was no significant difference in outcomes for staged and synchronous procedures and no comparable data for patients with combined cardiac and carotid disease not undergoing staged or synchronous surgery.
Naylor
A R
AR
Department of Vascular Surgery, Clinical Sciences Building, PO Box 65, Leicester Royal Infirmary, Leicester LE2 7LX, UK.
Cuffe
R L
RL
Rothwell
P M
PM
Bell
P R F
PR
D016893:Carotid Stenosis / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D016894:Endarterectomy, Carotid; D006801:Humans; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications