Chronic renal insufficiency and risk of early mortality in patients undergoing carotid endarterectomy.
We compared early outcome after carotid endarterectomy (CEA) in patients (n = 857 with 1,011 CEA interventions) with and without chronic renal insufficiency (CRI). Two groups were compared: a group with normal renal function (n = 909) and a group with CRI (creatinine >/=1.5 mg/dL and clearance of </=30 mL/min, as well as dialysis and transplant patients, n = 102). Mean age was significantly higher in CRI patients (71.22 vs. 68.33 years, p = 0.001). The incidence of smokers was 53.9% in the non-CRI group vs. 39.2% in CRI patients (p = 0.005). Hypertension (88.2% vs. 75.1, p = 0.003) and cardiac disease (58.8% vs. 47.4%, p = 0.029) were more common in the CRI group. The perioperative mortality rate was significantly higher in CRI patients (3.9% vs. 1.0%, p = 0.013). Multivariate logistic regression analysis showed a significant association between CRI and 30-day death rate (odds ratio = 3.76, p = 0.032). In this series, CRI patients presented an increased mortality. The mortality risk may be related to the increased rates of preoperative hypertension and coronary disease and perioperative myocardial infarction. A more reserved attitude seems indicated in planning CEA for patients with renal dysfunction in combination with a history of coronary artery disease.
Debing
Erik
E
Department of Vascular Surgery, Academic Hospital, Free University of Brussels, Brussels, Belgium. erik.debing@az.vub.ac.be
Van den Brande
Pierre
P
D000368:Aged; D001530:Belgium / Q000453:epidemiology; D016893:Carotid Stenosis / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D015994:Incidence; D016015:Logistic Models; D008297:Male; D009026:Mortality / Q000639:trends; D016017:Odds Ratio; D018579:Patient Selection; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome