The influence of concurrent carotid endarterectorny on coronary bypass: A case-controlled study

Background: Concurrent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) are associated with an increased incidence of stroke and death compared to isolated CABG. It is unclear whether this reflects two concurrent operative procedures or the increased risk in patients with more extensive atherosclerosis. Methods. To address this question, a case controlled study was performed using data from the New York State Cardiac Database from 1997 to 1998. Patients who underwent combined CEA-CABG were compared with all isolated CABG patients and a risk-matched cohort of isolated CABG patients. Results. The 35,539 isolated CABG patients had fewer postoperative complications than the 744 combined CEA-CABG patients, but also had a lower overall risk profile. The isolated CABG patients had a lower incidence of stroke (2% vs 5.1%), death (2% vs 4.4%), and combined stroke and death (3.7% vs 8.1%) compared with the combined group (P < .001). After risk-factor matching, no differences in stroke (5% vs 5.1%), death (3.9% vs 4.4%), or combined stroke and death (8.5% vs 8.1%) were observed. Conclusions. Although increased complications are reported after CEA-CABG, these do not differ from those of a risk-matched cohort of isolated CABG patients. Thus, the major morbidity of combined CEA-CABG is due to inherent patient risk and not the addition of CEA to CABG.