Background and Goal of Study
Prediction of major adverse cardiac and cerebrovascular event (MACCE) after off-pump coronary artery bypass surgery (OPCAB) would be of clinical importance and yet, it proves to be difficult. Carotid intima-media thickness (IMT) is a well-known predictor for MACCE in cardiac patients. However, evidence is limited regarding its predictive role on MACCE in patients undergoing surgical coronary revascularization, especially via OPCAB. Thus, we hypothesized that carotid IMT could be used for predicting MACCE after OPCAB.

Materials and Methods
Data from 323 patients who underwent OPCAB in a university hospital between April 2013 and October 2015 were retrospectively reviewed. MACCE was defined as the presence of cardiac arrest, acute myocardial infarction, congestive heart failure, angina, stroke, cardiovascular death, or cerebrovascular death in the follow-up period. Increased carotid IMT was defined as carotid IMT ≥0.9mm on one or both sides. We constructed logistic regression analyses to find independent risk factors including carotid IMT for the development of MACCE following OPCAB.

Results and Discussion
The incidence of MACCE was 7.5% in the normal IMT group vs. 15.3% in the increased IMT group (p=0.026). Patients in the increased IMT group were older with a higher incidence of Katz atheroma grade ≥4 (41.0% vs. 58.0%, p=0.002) relative to those of the normal IMT group. Multivariate logistic regression analysis revealed that history of diabetes mellitus and cerebrovascular accident, the number of grafts performed, and increased IMT (OR=2.271, 95% CI; 1.074 - 4.803, p=0.032) were independent predictors of MACCE. 

Conclusion
In patients undergoing OPCAB, routine assessment of carotid IMT may allow a more comprehensive risk stratification in terms of predicting the development of postoperative MACCE.

Impact of carotid intima-media thickness on the incidence of major adverse cardiac and cerebrovascular event after off-pump coronary artery bypass