Risk factors for carotid artery disease in patients scheduled for coronary artery bypass grafting.

BACKGROUND Carotid artery disease is thought to be a risk factor for neurological complications after cardiac surgery. Routine ultrasonographic screening is still not performed in every patient scheduled for coronary artery bypass grafting (CABG). AIM To assess factors which may facilitate the selection for elective carotid artery ultrasound examination in patients undergoing CABG. METHODS 682 patients (mean age 63.2 +/- 8.7, range: 37-85 years) scheduled for CABG underwent preoperative duplex ultrasound examination of the carotid arteries. The following factors were collected and analysed: age, sex, LVEF, history of cerebrovascular accidents (stroke and/or TIA), myocardial infarction, and presence of hypertension, diabetes, unstable angina, chronic obstructive pulmonary disease, chronic kidney disease, left main stenosis > or = 50%, lower-extremity peripheral arterial disease, and obesity (BMI > 30 kg/m(2)). Logistic regression analysis was used to determine the risk factors for carotid artery stenosis. RESULTS Internal or common carotid artery stenosis > or = 50% was detected in 123 (18%) patients. Bilateral stenosis occurred in 35 (5.1%) patients, of whom 29 (4.5%) presented at least a monolateral vessel diameter reduction of > or= 70%. History of cerebrovascular accidents, presence of lower-extremity peripheral arterial disease, and unstable angina were independent risk factors for at least monolateral vessel diameter reduction > or = 50%. Although older age was also an independent predictor (Exp(B) = 1.035, p < 0.05), the ROC curve analysis did not reveal an age threshold above which the probability of detecting carotid disease increases significantly with satisfying sensitivity and specificity. The predictors of bilateral stenosis (at least one of them > or = 70%) were a history of stroke, presence of left main disease, and lower-extremity peripheral arterial disease. CONCLUSIONS Carotid disease is common in patients scheduled for CABG. Preoperative carotid artery ultrasound examination should be performed, regardless of age, in all patients with more advanced symptomatic atherosclerosis, such as a history of cerebrovascular accidents, presence of lower-extremity peripheral arterial disease, left main disease, or unstable angina.