LAUSR

BACKGROUND Due to the systemic nature of atherosclerosis, arteries at different sites are commonly simultaneously affected. As a result, severe Coronary Artery Disease (CAD) requiring Coronary Artery Bypass Graft (CABG) frequently coexists with significant carotid stenosis that warrants revascularization. OBJECTIVE To compare simultaneous carotid endarterectomy (CEA) and CABG vs. staged CEA and CABG for patients with concomitant CAD and carotid artery stenosis in terms of peri-operative outcomes. METHODS This study was performed according to the PRISMA guidelines. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess for heterogeneity. RESULTS Eleven studies comprising 44,895 patients were included in this meta-analysis (21,710 in the synchronous group and 23,185 patients in the staged group). The synchronous CEA and CABG group had a statistically significant lower risk for myocardial infarction(MI) (OR:0.15;95%CI:0.04-0.61;I2=0%) and higher risk for stroke (OR:1.51;95%CI:1.34-1.71;I2=0%) and death (OR:1.33;95%CI:1.01-1.75;I2=47.8%). Transient ischemic attacks (TIA) (OR:1.27;95%CI:1.00-1.61;I2=0.0%), postoperative bleeding (OR:0.82;95%CI:0.22-3.05;I2=0.0%) and pulmonary complications (OR:1.52;95%CI:0.24-9.60;I2=67.5%) were similar between the two groups. CONCLUSIONS Patients in the simultaneous CEA and CABG group had a significantly higher risk of 30-day mortality and stroke and lower risk for MI as compared to staged CEA and CABG group. The rates of TIA, postoperative bleeding and pulmonary complications were similar between the two groups. Future randomized trials or prospective cohorts are needed to validate our results.