Objectives: To evaluate the potential benefit of systematic preoperative coronary-artery angiography followed by selective coronary-artery revascularization on the incidence of myocardial infarction (MI) in patients undergoing carotid endarterectomy (CEA) without a previous history of coronary artery disease (CAD). Methods: We randomised 426 patients who were candidates for CEA, with no history of CAD, a normalelectrocardiogram (ECG), and a normal cardiac ultrasound. In group A (n ¼ 216) all patients underwent coronary angiography before CEA. In group B (n ¼ 210) CEA was performed without coronary angiography. Patients were not blinded for relevant assessments during follow-up. Primary end-point was the occurrence of MI at 3.5 years. The secondary end-point was the overall survival rate. Median length of follow-up was 6.2 years. Results: In group A, coronary angiography revealed significant coronary artery stenosis in 68 patients (31.5%). Among them, 66 underwent percutaneous Intervention (PCI) prior to CEA and 2 received combined CEA and coronary-artery bypass grafting (CABG). Postoperatively, no MI was observed in group A, whereas 6 MI occurredin group B, one of which was fatal (p ¼ .01). During the study period, 3 MI occurred in group A (1.4%) and 33 were observed in group B (15.7%), 6 of whichwere fatal. The Cox model demonstrated a reduced risk of MI for patients in group A receiving coronary angiography (HR,.078; 95% CI, 0.024-0.256; p < .001). In addition, patients with diabetes and patients <70 yearspresented with an increased risk of MI. Survival analysis at 6 years by Kaplan-Meier estimates was 95.6 ? 3.2% in Group A and 89.7 ? 3.7% in group B (Log Rank ¼ 6.54, p ¼ .01). Conclusions: In asymptomatic coronary-artery patients, systematic coronary angiography prior to CEA followed by selective PCI or CABG significantly reduces the incidence of late MI and increases long-term survival. (ClinicalTrials.gov number, NCT02260453).

Long-term results of a randomized controlled trial analyzing the role of systematic pre-operative coronary angiography before elective carotid endarterectomy in patients with asymptomatic coronary artery disease / Illuminati, Giulio; F., Schneider; Greco, Cesare; Mangieri, Enrico; Schiariti, Michele Salvatore Maria; Tanzilli, Gaetano; Paravati, Vincenzo; Pizzardi, Giulia; F., Calio'; Miraldi, Fabio; Macrina, Francesco; M., Totaro; Mazzesi, Giuseppe; Tritapepe, Luigi; M., Toscano; Vietri, Francesco; N., Meyer; J. B., Ricco; Barilla', Francesco; Greco, Ernesto. - In: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY. - ISSN 1078-5884. - STAMPA. - 49:4(2015), pp. 366-374. [10.1016/j.ejvs.2014.12.030]

Long-term results of a randomized controlled trial analyzing the role of systematic pre-operative coronary angiography before elective carotid endarterectomy in patients with asymptomatic coronary artery disease

ILLUMINATI, Giulio;GRECO, Cesare;MANGIERI, Enrico;SCHIARITI, Michele Salvatore Maria;TANZILLI, Gaetano;PARAVATI, Vincenzo;pizzardi, giulia;MIRALDI, Fabio;MACRINA, Francesco;MAZZESI, Giuseppe;TRITAPEPE, Luigi;VIETRI, Francesco;BARILLA', Francesco;GRECO, Ernesto
2015

Abstract

Objectives: To evaluate the potential benefit of systematic preoperative coronary-artery angiography followed by selective coronary-artery revascularization on the incidence of myocardial infarction (MI) in patients undergoing carotid endarterectomy (CEA) without a previous history of coronary artery disease (CAD). Methods: We randomised 426 patients who were candidates for CEA, with no history of CAD, a normalelectrocardiogram (ECG), and a normal cardiac ultrasound. In group A (n ¼ 216) all patients underwent coronary angiography before CEA. In group B (n ¼ 210) CEA was performed without coronary angiography. Patients were not blinded for relevant assessments during follow-up. Primary end-point was the occurrence of MI at 3.5 years. The secondary end-point was the overall survival rate. Median length of follow-up was 6.2 years. Results: In group A, coronary angiography revealed significant coronary artery stenosis in 68 patients (31.5%). Among them, 66 underwent percutaneous Intervention (PCI) prior to CEA and 2 received combined CEA and coronary-artery bypass grafting (CABG). Postoperatively, no MI was observed in group A, whereas 6 MI occurredin group B, one of which was fatal (p ¼ .01). During the study period, 3 MI occurred in group A (1.4%) and 33 were observed in group B (15.7%), 6 of whichwere fatal. The Cox model demonstrated a reduced risk of MI for patients in group A receiving coronary angiography (HR,.078; 95% CI, 0.024-0.256; p < .001). In addition, patients with diabetes and patients <70 yearspresented with an increased risk of MI. Survival analysis at 6 years by Kaplan-Meier estimates was 95.6 ? 3.2% in Group A and 89.7 ? 3.7% in group B (Log Rank ¼ 6.54, p ¼ .01). Conclusions: In asymptomatic coronary-artery patients, systematic coronary angiography prior to CEA followed by selective PCI or CABG significantly reduces the incidence of late MI and increases long-term survival. (ClinicalTrials.gov number, NCT02260453).
2015
Coronary angiography; carotid endarterectomy; pre-operative cardiac workup
01 Pubblicazione su rivista::01l Trial clinico
Long-term results of a randomized controlled trial analyzing the role of systematic pre-operative coronary angiography before elective carotid endarterectomy in patients with asymptomatic coronary artery disease / Illuminati, Giulio; F., Schneider; Greco, Cesare; Mangieri, Enrico; Schiariti, Michele Salvatore Maria; Tanzilli, Gaetano; Paravati, Vincenzo; Pizzardi, Giulia; F., Calio'; Miraldi, Fabio; Macrina, Francesco; M., Totaro; Mazzesi, Giuseppe; Tritapepe, Luigi; M., Toscano; Vietri, Francesco; N., Meyer; J. B., Ricco; Barilla', Francesco; Greco, Ernesto. - In: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY. - ISSN 1078-5884. - STAMPA. - 49:4(2015), pp. 366-374. [10.1016/j.ejvs.2014.12.030]
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