Long-term results of a randomized controlled trial analyzing the role of systematic pre-operative coronary angiography before elective carotid endarterectomy in XXXX with asymptomatic @entity453 .

@entity1 @entity583 @entity6 @entity3979 @entity453
OBJECTIVES: To evaluate the potential benefit of systematic preoperative @entity453 angiography followed by selective @entity453 revascularization on the incidence of @entity583 ( @entity583 ) in @entity1 undergoing carotid endarterectomy (CEA) without a previous history of @entity453 ( @entity453 ). METHODS: We randomised 426 @entity1 who were candidates for CEA, with no history of @entity453 , a normal electrocardiogram (ECG), and a normal cardiac ultrasound. In group A (n  =  216) all @entity1 underwent coronary angiography before CEA. In group B (n  =  210) CEA was performed without coronary angiography. @entity1 were not blinded for relevant assessments during follow-up. Primary end-point was the occurrence of @entity583 at 3.5 years. The secondary end-point was the overall survival rate. Median length of follow-up was 6.2 years. RESULTS: In group A, coronary angiography revealed significant @entity3979 in 68 @entity1 (31.5%). Among them, 66 underwent percutaneous Intervention (PCI) prior to CEA and 2 received combined CEA and @entity453 bypass grafting (CABG). Postoperatively, no @entity583 was observed in group A, whereas 6 @entity583 occurred in group B, one of which was fatal (p  =  .01). During the study period, 3 @entity583 occurred in group A (1.4%) and 33 were observed in group B (15.7%), 6 of which were fatal. The Cox model demonstrated a reduced risk of @entity583 for @entity1 in group A receiving coronary angiography (HR,.078; 95% CI, 0.024-0.256; p  <  .001). In addition, @entity1 with @entity6 and @entity1 <70 years presented with an increased risk of @entity583 . Survival analysis at 6 years by Kaplan-Meier estimates was 95.6      3.2% in Group A and 89.7      3.7% in group B (Log Rank  =  6.54, p  =  .01). CONCLUSIONS: In asymptomatic @entity453 @entity1 , systematic coronary angiography prior to CEA followed by selective PCI or CABG significantly reduces the incidence of late @entity583 and increases long-term survival. (ClinicalTrials.gov number, NCT02260453).
