Long-term Results of a Randomized Controlled Trial Analyzing the Role of Systematic Pre-operative Coronary Angiography before Elective Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease
| Autor: | Vincenzo Paravati, Giuseppe Mazzesi, Francesco Macrina, Giulia Pizzardi, Francesco G. Calio, Giulio Illuminati, Luigi Tritapepe, Marco Totaro, Ernesto Greco, J.-B. Ricco, Enrico Mangieri, Francesco Vietri, Gaetano Tanzilli, Fabio Miraldi, Michele Schiariti, Cesare Greco, Michele Toscano, Francesco Barillà, Fabrice Schneider, N. Meyer |
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| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Coronary angiography medicine.medical_treatment Carotid endarterectomy Revascularization Asymptomatic law.invention Coronary artery disease Pre-operative cardiac workup Randomized controlled trial law Internal medicine medicine Myocardial infarction Medicine(all) medicine.diagnostic_test business.industry medicine.disease Surgery Conventional PCI Angiography Cardiology medicine.symptom Cardiology and Cardiovascular Medicine business carotid endarterectomy pre-operative cardiac workup |
| Zdroj: | European Journal of Vascular and Endovascular Surgery. 49:366-374 |
| ISSN: | 1078-5884 |
| DOI: | 10.1016/j.ejvs.2014.12.030 |
| Popis: | ObjectivesTo evaluate the potential benefit of systematic preoperative coronary-artery angiography followed by selective coronary-artery revascularization on the incidence of myocardial infarction (MI) in patients undergoing carotid endarterectomy (CEA) without a previous history of coronary artery disease (CAD).MethodsWe randomised 426 patients who were candidates for CEA, with no history of CAD, a normal electrocardiogram (ECG), and a normal cardiac ultrasound. In group A (n = 216) all patients underwent coronary angiography before CEA. In group B (n = 210) CEA was performed without coronary angiography. Patients were not blinded for relevant assessments during follow-up. Primary end-point was the occurrence of MI at 3.5 years. The secondary end-point was the overall survival rate. Median length of follow-up was 6.2 years.ResultsIn group A, coronary angiography revealed significant coronary artery stenosis in 68 patients (31.5%). Among them, 66 underwent percutaneous Intervention (PCI) prior to CEA and 2 received combined CEA and coronary-artery bypass grafting (CABG). Postoperatively, no MI was observed in group A, whereas 6 MI occurred in group B, one of which was fatal (p = .01).During the study period, 3 MI occurred in group A (1.4%) and 33 were observed in group B (15.7%), 6 of which were fatal. The Cox model demonstrated a reduced risk of MI for patients in group A receiving coronary angiography (HR,.078; 95% CI, 0.024-0.256; p |
| Databáze: | OpenAIRE |
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