title: Current outcomes of simultaneous carotid endarterectomy and coronary artery bypass graft surgery in North America.
abstract: 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. Although no strict comparison group is available, this study defines current outcomes of SCC, compared qualitatively to two reference categories.
  
  
  METHODS
  Utilizing the STS database from 2003 to 2007, patients who had SCC were compared with patients with cerebrovascular disease who had coronary bypass (CABG) with prior carotid endarterectomy (CEA), and those with carotid Doppler stenosis >75% and no carotid intervention. Logistic regression analysis adjusted for differences in baseline characteristics and operative mortality (OM), and a composite of neurological complications (NC) was assessed.
  
  
  RESULTS
  Of 745,769 patients who underwent isolated CABG with/without CEA, 108,212 (14%) had cerebrovascular disease. Of this group, 5,732 (5%) underwent SCC. The SCC group had more males and lower preoperative risk factors. After statistical adjustment for all baseline differences, SCC had clinically and statistically higher OM and NC compared with any of the reference groups, with 20-40% higher event risk.
  
  
  CONCLUSIONS
  Although no quantitative control group exists for comparison, SCC as recently performed in North America has a high risk compared with 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.
authors.affiliation: Division of Cardiothoracic Surgery, University of Illinois at Chicago, 840 South Wood, CSB 417, Chicago, IL 60612, USA. smprasad@uic.edu
authors.forename: Sunil M
authors.initials: SM
authors.lastname: Prasad
authors.forename: Shuang
authors.initials: S
authors.lastname: Li
authors.forename: J Scott
authors.initials: JS
authors.lastname: Rankin
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.forename: Edgar G
authors.initials: EG
authors.lastname: Chedrawy
authors.forename: Malek G
authors.initials: MG
authors.lastname: Massad
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / 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; D009656:North America; D016896:Treatment Outcome