Prevalence and impact of carotid disease in adult Saudi patients undergoing isolated coronary artery bypass surgery on early postoperative outcome

Abstract

The aim of the study is to assess the prevalence of carotid disease in our Saudi population undergoing coronary artery bypass surgery and to determine its impact on stroke and early postoperative outcome. A total of 3197 consecutive adult patients underwent major cardiac surgery in our center between January 2002 and December 2012. Of these, 3150 had preoperative duplex scanning, and out of these, 210 patients (6.6%) had significant carotid artery disease defined as ≥75% stenosis (Group A), whereas 2940 (94.4%) were free from carotid artery disease (Group B). Both groups were compared for the presence of preoperative risk factors and for occurrence of adverse events within 30 days, postoperative period. In univariate analysis, preoperative risk factors for the presence of carotid artery stenosis were diabetes mellitus (P < 0.0001); hypertension (P < 0.0001); past cerebrovascular accident (CVA) (P < 0.0001), and peripheral vascular disease (PVD; P < 0.0001). All-cause in-hospital mortality was high in Group A in comparison with Group B (3.8 vs. 1.56%; P = 0.004). The morbidity was also high in Group A compared with Group B in terms of stroke (4.3 vs. 1.6%; P = 0.0014), nosocomial pneumonia (16.4 vs. 8.9%; P = 0.0015), leg wound infection (14.2 vs. 6%; P = 0.0001), septicaemia (9.3 vs. 4.8%; P = 0.013), acute limb ischaemia (1.1 vs. 0.4%; P = 0.034), new onset atrial fibrillation (AFIB) (26.8 vs. 16.3%; P = 0.0005), ventricular fibrillation (4.9 vs. 1.5%; P = 0.0035), and renal dysfunction (11 vs. 4.9%; P = 0.0017). The presence of carotid artery disease in Saudi patients undergoing cardiac surgery is associated with increased prevalence of diabetes, hypertension, CVA, and PVD. It is also a major determinant of adverse outcome after coronary surgery.