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.
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