title: Influence of carotid injury in post-myocardial revascularization surgery and its late evolution.
abstract: BACKGROUND
  Approximately 30% of perioperative CVA of myocardial revascularization surgery (MRS) are a result of carotid injuries, without reduction of risk confirmed by perioperative intervention.
  
  
  OBJECTIVE
  Evaluate the impact of carotid disease and perioperative intervention in patients subjected to MRS.
  
  
  METHODS
  Observational, retrospective study, evaluating 1169 patients aged > 69 years undergoing MRS from January, 2006 and December, 2010, monitored, on average, for 49 months. All patients were subjected to ultrasonography of carotids before MRS. It was defined as carotid disease when lesion > 50%. The primary outcome was composed of CVA incidence, transitory ischemic accident (TIA) and death due CVA.
  
  
  RESULTS
  Prevalence of carotid disease was of 19.9% of patients. The incidence of primary outcome between unhealthy and healthy patients was of 6.5% and 3.7%, respectively (p = 0.0018). In the first 30 days, there were 18.2% of events. Were related to carotid disease: renal dysfunction (OR 2.03, IC95% 1.34-3.07; p < 0.01), peripheral arterial disease (OR 1.80, IC95% 1.22-2.65; p < 0.01) and previous myocardial infarction (OR 0.47, IC95% 0.35-0.65; p < 0.01). Regarding the primary outcome, were associated the previous TIA (OR 5.66, IC95% 1.67-6.35; p < 0.01) and renal dysfunction (OR 3.28, IC95% 1.67-6.45; p < 0.01). In patients with lesion >70%, perioperative carotid intervention demonstrated an incidence of 16% in primary outcome compared to 4.3% in conservatory treatment (p = 0.056) with no difference between percutaneous and surgical approaches (p = 0.516).
  
  
  CONCLUSIONS
  Carotid disease increases the risk of CVA, TIA or death due to CVA in MRS. However, the carotid intervention was not related to reduction of primary outcome.
authors.forename: Maria Sol Calero
authors.initials: MS
authors.lastname: Revelo
authors.forename: Daniel Pio de
authors.initials: DP
authors.lastname: Oliveira
authors.forename: Flávia Bittar Britto
authors.initials: FB
authors.lastname: Arantes
authors.forename: Camila Camarço
authors.initials: CC
authors.lastname: Batista
authors.forename: João Italo Dias
authors.initials: JI
authors.lastname: França
authors.forename: Silmara Cristina
authors.initials: SC
authors.lastname: Friolani
authors.forename: Jorge Eduardo
authors.initials: JE
authors.lastname: Assef
authors.forename: José Eduardo Martins
authors.initials: JE
authors.lastname: Barbosa
authors.forename: Ana Claudia
authors.initials: AC
authors.lastname: Petisco
authors.forename: Pedro Silvio
authors.initials: PS
authors.lastname: Farsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020212:Carotid Artery Injuries / Q000150:complications* / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000009:adverse effects* / Q000401:mortality; D059035:Perioperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome