Cardiac events after carotid endarterectomy: long-term results.

BACKGROUND: The aim of this study was to evaluate the incidence of late cardiac events in patients submitted to carotid endarterectomy (CEA), asymptomatic for coronary artery disease during the carotid surgical procedure. METHODS: During a period of 11 years, 162 patients (122 males, 40 females, mean age 68 +/- 12 years), asymptomatic for coronary artery disease and/or without sings of coronary artery disease at the cardiological screening, were submitted to CEA for symptomatic or severe (> or = 70%) carotid stenoses. Clinical follow-up was performed on 151 patients (93%), to identify the incidence of cardiac and neurological events and freedom from late death. The results of this group of patients (group A) were compared to those obtained during follow-up of 147 patients (133 males, 14 females, mean age 69 +/- 15 years) (group B) affected by coronary artery disease and submitted to combined CEA and coronary artery bypass grafting (CABG). RESULTS: During follow-up, in group A freedom from late death, cardiac death and adverse neurological events were 77 +/- 4.8, 86 +/- 4.4 and 87.3 +/- 4.5% at 9 years, respectively. Freedom from adverse neurological events in group A was similar to that registered in group B (86.4 +/- 5.6%, p = NS). The incidence of cumulative cardiac events and fatal cardiac events (myocardial infarction, sudden death, congestive heart failure) on the contrary, was higher in group A than in group B (13.2 vs 6.8%, p = 0.0424, and 7.9 vs 3.4%, p = 0.0446, respectively). CONCLUSIONS: In patients submitted to isolated CEA, although without symptoms or signs of coronary artery disease at the timing of the carotid procedure, the possibility of a severe coronary disease development during follow-up is not negligible: the incidence of late cardiac events may be higher than in patients with coronary artery disease corrected at the same time of the CEA procedure. These data suggest the opportunity of a systematic cardiological screening during follow-up in patients submitted to isolated CEA, although clinically asymptomatic for coronary artery disease at the timing of the vascular procedure, to improve the long-term survival.