Risk factors for carotid artery disease in patients scheduled for coronary artery bypass grafting.
BACKGROUND
Carotid artery disease is thought to be a risk factor for neurological complications after cardiac surgery. Routine ultrasonographic screening is still not performed in every patient scheduled for coronary artery bypass grafting (CABG).


OBJECTIVE
To assess factors which may facilitate the selection for elective carotid artery ultrasound examination in patients undergoing CABG.


METHODS
682 patients (mean age 63.2 +/- 8.7, range: 37-85 years) scheduled for CABG underwent preoperative duplex ultrasound examination of the carotid arteries. The following factors were collected and analysed: age, sex, LVEF, history of cerebrovascular accidents (stroke and/or TIA), myocardial infarction, and presence of hypertension, diabetes, unstable angina, chronic obstructive pulmonary disease, chronic kidney disease, left main stenosis > or = 50%, lower-extremity peripheral arterial disease, and obesity (BMI > 30 kg/m(2)). Logistic regression analysis was used to determine the risk factors for carotid artery stenosis.


RESULTS
Internal or common carotid artery stenosis > or = 50% was detected in 123 (18%) patients. Bilateral stenosis occurred in 35 (5.1%) patients, of whom 29 (4.5%) presented at least a monolateral vessel diameter reduction of > or= 70%. History of cerebrovascular accidents, presence of lower-extremity peripheral arterial disease, and unstable angina were independent risk factors for at least monolateral vessel diameter reduction > or = 50%. Although older age was also an independent predictor (Exp(B) = 1.035, p < 0.05), the ROC curve analysis did not reveal an age threshold above which the probability of detecting carotid disease increases significantly with satisfying sensitivity and specificity. The predictors of bilateral stenosis (at least one of them > or = 70%) were a history of stroke, presence of left main disease, and lower-extremity peripheral arterial disease.


CONCLUSIONS
Carotid disease is common in patients scheduled for CABG. Preoperative carotid artery ultrasound examination should be performed, regardless of age, in all patients with more advanced symptomatic atherosclerosis, such as a history of cerebrovascular accidents, presence of lower-extremity peripheral arterial disease, left main disease, or unstable angina.
Drohomirecka
Anna
A
MEDINET Heart Center, Wroclaw, Poland. adrohomirecka@tlen.pl
Kołtowski
Lukasz
L
Kwinecki
Paweł
P
Wronecki
Krzysztof
K
Cichoń
Romuald
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000453:epidemiology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000453:epidemiology; D014463:Ultrasonography