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Influence of carotid injury in post-myocardial revascularization surgery and its late evolution.

Authors :
Revelo MS
Oliveira DP
Arantes FB
Batista CC
França JI
Friolani SC
Assef JE
Barbosa JE
Petisco AC
Farsky PS
Source :
Arquivos brasileiros de cardiologia [Arq Bras Cardiol] 2013 Oct; Vol. 101 (4), pp. 297-303. Date of Electronic Publication: 2013 Sep 06.
Publication Year :
2013

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.<br />Objectives: Evaluate the impact of carotid disease and perioperative intervention in patients subjected to MRS.<br />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.<br />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).<br />Conclusion: 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.

Details

Language :
English; Portuguese
ISSN :
1678-4170
Volume :
101
Issue :
4
Database :
MEDLINE
Journal :
Arquivos brasileiros de cardiologia
Publication Type :
Academic Journal
Accession number :
24008654
Full Text :
https://doi.org/10.5935/abc.20130183