title: Atrial fibrillation is associated with increased risk of perioperative stroke and death from carotid endarterectomy.
abstract: BACKGROUND
  Carotid endarterectomy is performed in high volume in the United States. Identifying patients with a higher risk of stroke and death after carotid endarterectomy can lead to modifications in care that would significantly reduce the occurrence of these events. This study evaluates whether atrial fibrillation is significantly associated with an increased risk of death or stroke for patients undergoing carotid endarterectomy.
  
  
  METHODS
  This retrospective cohort study uses multivariable logistic regression analysis to assess the relationship between atrial fibrillation and death and/or stroke after carotid endarterectomy. The study population is drawn from the National Inpatient Sample, 2005. All patients with a primary carotid endarterectomy and diagnosis of stenosis of precerebral arteries were included, except patients with concomitant open heart procedures. The main outcomes examined were in-hospital death and stroke, adjusted for age, gender, symptomatic status, and for comorbid disease.
  
  
  RESULTS
  Carotid endarterectomy was performed for 20,022 patients. Strokes occurred in 189 patients (0.94%), and death occurred in 59 (0.29%). Patients with atrial fibrillation had significantly higher adjusted odds of stroke or death (odds ratio = 2.45; P < .0001).
  
  
  CONCLUSIONS
  Patients with atrial fibrillation have a substantially higher risk of stroke and death after carotid endarterectomy.
authors.affiliation: Division of Vascular Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Harthun
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology