Faculty Collaboration Database

Meta-analysis of staged versus combined carotid endarterectomy and coronary artery bypass grafting. Ann Thorac Surg 2014 Jan;97(1):102-9

Date

10/05/2013

Pubmed ID

24090581

DOI

10.1016/j.athoracsur.2013.07.091

Scopus ID

2-s2.0-84891590980 (requires institutional sign-in at Scopus site)   63 Citations

Abstract

BACKGROUND: The multiple options in the management of patients with concomitant carotid and coronary artery disease (CAD) make it difficult to find a clear consensus regarding the ideal surgical strategy. We performed a meta-analysis of studies comparing early outcomes of synchronous and staged approach of carotid endarterectomy and coronary artery bypass grafting.

METHODS: All English language publications were searched using the terms "carotid artery disease," "coronary artery disease," "carotid endarterectomy," and "coronary artery bypass grafting" alone or in combination. The endpoints studied were early mortality, major stroke, and major postoperative morbidity; myocardial infarction (MI) and stroke, and combined early mortality or stroke. Early events were compared using pooled estimates of risk ratios (RR) (random effects model) utilizing the inverse-variance method.

RESULTS: Twelve studies were identified with a total of 17,469 and 7,552 patients in the combined and staged group, respectively. The pooled analysis revealed no difference in the early mortality (RR 1.36 [0.78, 2.36]; p = 0.27), post operative stroke (RR 1.14 [0.99, 1.31], p = 0.07), combined early mortality or stroke (RR 1.08 [0.98, 1.20], p = 0.11) and combined endpoint of MI or stroke (RR 0.75 [0.48, 1.17; I(2) = 11%], p = 0.2) between the 2 surgical approaches.

CONCLUSIONS: Our meta-analysis of observational studies suggests comparable outcomes in combined and staged approach for synchronous carotid and coronary artery disease. Hence, the 2 strategies can be used interchangeable in the clinical practice, with each having specific applications linked to specific clinical conditions. A randomized trial is warranted to answer this question definitively.

Author List

Sharma V, Deo SV, Park SJ, Joyce LD

MESH terms used to index this publication - Major topics in bold

Carotid Stenosis
Combined Modality Therapy
Coronary Artery Bypass
Coronary Stenosis
Endarterectomy, Carotid
Female
Hospital Mortality
Humans
Male
Myocardial Infarction
Prognosis
Randomized Controlled Trials as Topic
Risk Assessment
Stroke
Survival Analysis
Treatment Outcome