Diagnosis and management of silent coronary ischemia in patients undergoing carotid endarterectomy

BackgroundCoronary artery disease is the primary cause of death in patients with carotid and silent ischemia a marker for adverse coronary events. A new noninvasive cardiac diagnostic test, computed tomography-derived fractional flow reserve (FFRCT) can reliably identify ischemia-producing stenosis help to select revascularization. The purpose this study determine prevalence undergoing endarterectomy (CEA) evaluate usefulness FFRCT selecting revascularization decrease events improve survival.MethodsPatients no history or symptoms admitted elective CEA were enrolled prospective, open-label, institutional review board-approved underwent preoperative tomography angiography (CTA) results available physicians patient management. Lesion-specific was defined as 0.80 less distal focal an 0.75 less, indicating severe ischemia. Primary end point incidence major cardiovascular (MACE; death, myocardial infarction, stroke) at 30 days 1 year.ResultsCoronary CTA performed 90 (age 67 ± 8 years; male 66%). found 51 (57%) mean 0.71 0.14. Severe present 39 (43%), 26 had multivessel ischemia, 5 left main disease. scheduled all postoperative deaths infarctions. There MACE days. After recovery from surgery, 36 significant lesion-specific (percutaneous intervention bypass grafting) (33%). Survival year 100% freedom 98%.ConclusionsPatients have high unsuspected (silent) which may place them risk Preoperative diagnosis using high-risk guide Selective survival, but longer follow-up needed controlled trials are indicated.