Clinical Impact of Routine Cardiology Consultation Prior to Elective Carotid Endarterectomy in Neurologically Asymptomatic Patients

Abstract

The aim was to determine the clinical impact of routine cardiology consultation before carotid endarterectomy (CEA) in neurologically asymptomatic patients, in terms of early and long term cardiovascular events. A single centre retrospective review of consecutive patients receiving CEA from 2007 to 2017 for asymptomatic carotid stenosis was performed. Two groups were compared: patients operated on from 2007 to 2012 received a pre-operative cardiology consultation only in selected cases (group A); from 2012 to 2017 patients received a routine pre-operative cardiology consultation (group B). In hospital death, myocardial infarction (MI), heart failure, dysrhythmias, and stroke were compared. A multiple logistic regression was performed to identify predictors of peri-operative complications. Long term overall survival and freedom from fatal cardiovascular events were compared. In total, 878 CEAs were performed in group A and 1094 in group B. Patients in group B were more likely to have had a previous coronary intervention (0.5% vs. 5.1%; p<.001), and to be on dual antiplatelet (4.6% vs. 9.5%; p=.001), statin therapy (60.3% vs. 72.4%; p<.001), and a higher number of cardiac drugs (1.77±1.22 vs. 1.92±1.23; p=.01) at the time of CEA. In hospital mortality was 0.1% for both groups (p=1.0), and there were no significant differences regarding neurological complications (0.8% vs. 0.3%; p=.20); group B had a significant reduction in overall cardiac complications (3.4% vs. 1.9%; p=.05) and MI (1.6% vs. 0.6%; p=.05). Multivariable analysis confirmed that routine cardiology consultation was an independent predictor of MI (odds [OR] ratio 0.61; p=.04) and overall reduction in cardiac complications (OR 0.28; p=.01). At five years, overall survival was similar (84.2% vs. 82.4%; p=.72), but patients in group B had a significantly lower mortality from cardiovascular events (92.0% vs. 95.8%; p=.04). Routine cardiology consultation before elective CEA in patients with asymptomatic carotid stenosis reduced peri-operative cardiac complications and long term fatal cardiovascular events. This approach may be considered to maximise the risk/benefit ratio of CEA in asymptomatic patients.