Prevalence and prognostic effects of comorbid coronary artery disease detected in patients undergoing carotid endarterectomy

Abstract

Abstract Introduction Coronary artery disease (CAD) shares common risk factors with carotid artery stenosis and is a known perioperative risk factor for carotid endarterectomy (CEA). It is feasible to perform CEA with continuation of antiplatelet drugs, including dual antiplatelet therapy. Differing opinions exist with respect to detection of CAD prior to CEA. To support the discussions, we aimed to assess recent prevalence and prognostic effects of comorbid CAD in patients undergoing CEA without known CAD. Methods This single-center prospective cohort study included patients scheduled for elective CEA between 2013 and 2021. Of these, 108 patients without a medical history of CAD (mean age 76.6±7.3 years, 73.1% men) underwent coronary computed tomography angiography (CCTA). Coronary angiography (CAG) and subsequent fractional flow reserve (FFR) estimation were performed where necessary. CAD was defined as total or subtotal occlusion observed on CCTA, ≥75% stenosis on CAG, or lesions with FFR ≤ 0.80 in the major coronary arteries. Optimal medical therapy and/or coronary revascularization was added according to the presence, severity, and extent of CAD. The primary endpoint was MACE (the composite of all-cause mortality, myocardial infarction, or stroke) after CEA. Results The prevalence of comorbid CAD was 19.4% (21 of 108 patients). During a mean follow-up of 4.0 years, the incidence of MACE and stroke was significantly higher in patients with CAD (adjusted HR: 3.10, 95% CI: 1.43–6.71, p=0.0042 and HR: 2.76, 95% CI 1.08–7.31, p=0.041, respectively). Other than patient age, only CAD was a significant predictor of MACE. Conclusions CAD is commonly detected in patients undergoing CEA, and it predicts future MACE and stroke event.