Carotid Atherosclerosis is Associated with In-hospital Mortality After CABG Surgery

Atherosclerosis is a widespread disease involving coronary and extra coronary arteries. Few data are reported about the association between degree of arterial involvement and in-hospital mortality rate in patients undergoing coronary artery bypass grafting (CABG). Aim of the present study was to evaluate whether carotid, femoral and abdominal aorta atherosclerosis, detected by ultrasound, is associated with inhospital mortality in patients undergoing CABG. All patients undergoing coronary angiography and candidates to CABG, visited between January 1997 and November 1998 at the Institute of Cardiovascular Surgery of the Second University of Naples, underwent coronary heart disease (CHD) risk factors evaluation and complete echo-Doppler study. Out of 600 patients enrolled, 34 died before discharge. Both groups, survivors and deceased, were analyzed for studied variables. Hyperlipidemia was more prevalent among subjects who survived (30% vs. 18%, p<0.0001). Subjects who died were significantly older (64.1 ± 7.8 vs. 60.0 ± 9.4 years, mean ± SD, p<0.01), had higher prevalence of diabetes mellitus (56% vs. 29%, p <0.0008), carotid atherosclerosis (85% vs. 60%, p <0.003), left ventricular ejection fraction (EF) <40% (47% vs. 23%, p<0.001), and previous CABG surgery (5.8% vs. 1.2%, p<0.003). In multiple logistic regression analysis, only diabetes mellitus, EF <40%, and carotid atherosclerosis were significantly and independently associated with CABG outcome. The present findings demonstrate that echoDoppler evaluation, at least of the carotid arteries, in addition to classical CHD risk factors, can help to predict the outcome after CABG surgery. Introduction Coronary artery bypass grafting (CABG) is the most frequently performed cardiac operation nowadays [20]. Postoperative mortality following routine, elective CABG is rather low, ranging from 1 to almost 5% [1,12], though cerebral and peripheral vascular complications may severely limit postoperative recovery and quality of life [11,27,28]. Coronary heart disease has been already shown to represent only a part of a more generalized atherosclerotic disease, and a clear correlation [6,7,29,31] has been found between extent of coronary artery disease and incidence of carotid and/or peripheral vascular disease. Nevertheless there is still a lack of guidelines about which preoperative vascular investigations should be performed in a patient undergoing CABG: some authors [18,21] are limiting preoperative vascular investigations to those patients with symptoms and/or clinical signs of associated vascular disease (e.g. carotid bruit or peripheral pulse losses); others [2,9,13,16], in order to prevent and reduce the incidence of postoperative cerebrovascular events, are performing routinely preoperative Echo-Doppler screening of carotid vessels. Very few studies [29] are reporting complete preoperative vascular investigations, including carotid and lower limb arteries in patients undergoing CABG, in order to stadiate the degree of atherosclerotic disease and to prevent postoperative complications. The aim of the present study was to evaluate whether a complete echo-Doppler study of carotid, and iliacofemoral arteries, in addition to CHD risk factors evaluation, can be of help in predicting perioperative inhospital mortality in patients undergoing CABG. Subjects and Methods Between January 1997 and November 1998, all patients referred for CABG to the Institute of Cardiovascular Surgery of the Second Correspondence to: Agostino Gnasso, M.D., Policlinico Mater Domini, Via T. Campanella, Catanzaro, Italy International Journal of Angiology 11: 210 – 215 (2002) DOI: 10.1007/s00547-002-0912-z