title: Lack of association between carotid artery stenosis and stroke or myocardial injury after noncardiac surgery in high-risk patients.
abstract: BACKGROUND
  Whether carotid artery stenosis predicts stroke after noncardiac surgery remains unknown. We therefore tested the primary hypothesis that degree of carotid artery stenosis is associated with in-hospital stroke or 30-day all-cause mortality after noncardiac surgery. As carotid artery stenosis is also a marker for cardiovascular disease, our secondary hypothesis was that degree of carotid artery stenosis is associated with postoperative myocardial injury.
  
  
  METHODS
  We included adults who had noncardiac, noncarotid surgery at Cleveland Clinic from 2007 to 2011 and had carotid duplex ultrasound performed either within 6 months before or 1 month after surgery. Internal carotid artery peak systolic velocity (ICA PSV) was used as a measure of carotid artery stenosis severity. A multivariate (i.e., multiple outcomes per patient) generalized estimating equation model was used to assess the association between highest ICA PSV and the composite of stroke and 30-day mortality after adjusting for predefined potentially confounding variables.
  
  
  RESULTS
  Of 2,110 patients included, 112 (5.3%) died within 30 days and 54 (2.6%) suffered postoperative in-hospital stroke. ICA PSV was not associated with this composite outcome (odds ratio of 1.0 [95% confidence interval: 0.99, 1.02] for a 10-unit increase, P = 0.55). ICA PSV was also not associated with postoperative myocardial injury (odds ratio 1.00 [0.99, 1.02], P = 0.49).
  
  
  CONCLUSIONS
  This cohort represents a high-risk population, as carotid duplex examinations were likely prompted by neurological symptoms. There was nonetheless no association between carotid artery stenosis and perioperative stroke or 30-day mortality after noncardiac surgery.
authors.affiliation: From the Department of Cardiothoracic Anesthesiology, Anesthesiology Institute (A.S.), Department of Vascular Medicine, Heart and Vascular Institute (H.L.G.), Department of Quantitative Health Sciences (D.Y., E.J.M.), and Department of Outcomes Research (D.Y., E.J.M., D.I.S.), Cleveland Clinic, Cleveland, Ohio.
authors.forename: Abraham
authors.initials: A
authors.lastname: Sonny
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gornik
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Yang
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mascha
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012306:Risk; D020521:Stroke / Q000503:physiopathology*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*