Author + information
- Merije Chukumerije,
- Lucas Christianson,
- Miyako Igari,
- Anilkumar Mehra,
- David Shavelle,
- Leonardo Clavijo and
- Ray Matthews
High-risk patients for severe carotid stenosis are defined as those with age >65 years, left main disease, peripheral arterial disease, history of cerebrovascular disease, hypertension, smoking or diabetes. Little has been published on patients from low socioeconomic populations and minority groups.
Identify incidence and pertinent risk factors of carotid disease in indigent patients with known coronary artery disease.
A retrospective analysis of LAC+USC Medical Center coronary artery bypass patients from January 2008 to December 2013 was performed. Patient demographics admitted to our institution during this time period were primarily non-Caucasian patients (88.5%), of which almost half where Hispanic (47.4%). A univariate and multivariate analysis were performed to identify pertinent risk factors for atherosclerotic carotid disease among our patients.
There were 574 (76.8% male, 23.2% female) patients that underwent coronary artery bypass grafting that had carotid ultrasounds performed. Of these patients 34 (5.9%) had significant carotid stenosis of ≥80%. The average age of the patients was 59.3±8.1 years. Patients with severe carotid stenosis were significantly older (59.1±8.2 vs. 61.4±6.1, p 0.05). Left main disease (odds ratio 2.18, 95% CI 1.05-4.50, p 0.03) and a history of cerebral vascular event (odds ratio 3.35, 95% CI 1.24-8.22, p 0.01) were significant risk factors for significant carotid stenosis. Post-operative cerebral vascular events occurred in 12 patients (2.1%). There was no significant difference in post-operative cerebral vascular events between those with significant carotid stenosis and those without. Overall in-hospital mortality was 1.2%. There was a significant difference in mortality between those with significant carotid stenosis and those without (3 (8.8%) vs. 4 (0.7%), p 0.006).
The incidence of significant carotid stenosis in this population is low. Patients with severe carotid stenosis were significantly older than those without. Of the risk factors reported in guidelines only presence of left main disease and a prior history of cerebral vascular event were significant risk factors for severe carotid stenosis in this population. In our population incidence of severe carotid stenosis is lower than others have previously reported and traditional risk factors were not as predictive.