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  • Title: Concomitant severe carotid and coronary artery diseases: a separate management or concomitant approach.
    Author: Chan JSK, Shafi AMA, Grafton-Clarke C, Singh S, Harky A.
    Journal: J Card Surg; 2019 Sep; 34(9):803-813. PubMed ID: 31269295.
    Abstract:
    OBJECTIVE: To systematically compare outcomes between patients with asymptomatic carotid artery diseases (>80% stenosis) that had undergone staged carotid endarterectomy (CEA) before coronary artery bypass grafting (CABG) vs simultaneous CEA and CABG. METHODS: A comprehensive electronic search of MEDLINE, Scopus, EMBASE, and Ovid from their inception up till August 2018 was performed to identify all studies comparing staged CEA followed by CABG to simultaneous CEA and CABG. Primary outcome measure was postoperative stroke, and secondary measures were myocardial infarction (MI) and 30-day mortality rates. RESULTS: A total of 67 953 patients were analyzed from 11 articles. There was higher rate of previous stroke in the staged cohort (2.64% vs 2.32%; odds ratio [OR], 0.81; 95% confidence interval [CI; 0.66, 0.99]; P = .040). There was no difference in previous MI (P = .57) or unstable angina (P = .08) among both cohorts. Postoperatively, there were higher stroke rates (3.64% vs 2.83%; OR, 0.72; 95% CI [0.62-0.89]; P < .0001), operative mortality (4.32% vs 3.58%; OR, 0.90; 95% CI [0.83-0.98]; P = .02), and 30-day mortality (4.40% vs 3.58%; OR, 0.86; 95% CI [0.78-0.96]; P = .006) in the simultaneous cohort. However, length of stay was significantly shorter in the simultaneous cohort (11.9 days vs 12.6 days; weighted mean difference 3.14 [0.77-5.51]; P = .009). There were no significant differences in 1-year mortality (P = .33), MI rates (P = .08), and rates of transient neurological deficits (P = .06). CONCLUSION: The results from this study favors staged CEA with CABG with lower incidence of postoperative stroke, operative, and 30-day mortality. A larger study, ideally a randomized controlled trial, is required to address the superiority of each technique.
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