Risk factors for myocardial infarction during carotid endarterectomy in high-risk patients with coronary artery disease

Abstract

Aim. To determine the value of various risk factors for predicting the myocardial infarction (MI) during carotid endarterectomy in high-risk patients with coronary artery disease (CAD).Material and methods. The single-center cohort prospective study included 204 high-risk patients with CAD who required carotid endarterectomy (CEA). Before surgery, all patients underwent treatment of CAD, and all patients were clinically stabilized. The first step was CEA. Clinical and diagnostic factors associated with the risk of perioperative MI were studied. There were following end points of the study: stroke, MI, death due to MI. The diagnosis of MI was established when there was a combination of an increase in cTn-I troponin above the 99th percentile upper reference limit with electrocardiographic manifestations of myocardial ischemia, or with chest pain or equivalent symptoms consistent with myocardial ischemia.Results. There were no strokes. There were no deaths due to MI. Perioperative MI developed in 8 (3,9%) patients. There were following most significant predictors of perioperative MI: severe impairment of local left ventricular (LV) contractility (hazard ratio (HR), 13,57; 95% confidence interval (CI), 1,427-124,782, p<0,05) and a decrease in left ventricular ejection fraction <50% (HR, 10,909; 95% CI, 1,052-271,229, p<0,05). However, following factors were insignificant for predicting perioperative MI (p>0,05): SYNTAX score, prior cerebrovascular accident, myocardial infarction, insulin-dependent diabetes mellitus, obesity, chronic obstructive pulmonary disease.Conclusion. In high-risk patients with CAD, severe impairment of local LV contractility and global LV systolic dysfunction are the most significant risk factors for perioperative MI during CEA.