In an RCT, 426 patients planned for CEA and without a history of CAD and normal electrocardiogram (ECG) and cardiac ultrasound were randomized to either systematic coronary angiography (with subsequent revascularization) or no coronary angiography.382 Significant CAD was found (and treated) before CEA in 39% of those randomized to angiography, with no postoperative MI, vs. 2.9% in the no-angiography group (P = 0.01). Importantly, PCI delayed CEA by a median of 4 days (range 1–8 days), without neurological events and without bleeding complications in patients on DAPT. At 6 years, patients allocated to systematic coronary angiography had a lower rate of MI (1.4% vs. 15.7%; P < 0.01) and improved survival (95% vs. 90%; P < 0.01).383 Hence routine preoperative coronary angiography may be considered in patients undergoing elective CEA.
