Midterm outcomes of simultaneous carotid revascularization combined with coronary artery bypass grafting

BMC Cardiovascular Disorders

Research

Maozhou Wang¹  Hongjia Zhang¹  Songhao Jia¹  Wenjian Jiang¹  Ming Gong¹ 

[1] Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China;

关键词: Carotid endarterectomy;    Carotid artery stenting;    Coronary artery bypass grafting;    Mid-term outcome;   

DOI  :  10.1186/s12872-022-02986-y

 received in 2022-07-14, accepted in 2022-11-30,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundSimultaneous carotid endarterectomy (CEA) combined with coronary artery bypass grafting (CABG) has been widely used in patients with coronary heart disease complicated with severe carotid stenosis to reduce the risk of stroke and death. Carotid artery stenting (CAS) has been proven to be an alternative to CEA in recent years. We investigated the early and mid-term outcomes of simultaneous CEA or CAS combined with CABG in these patients.MethodsFrom January 2011 to January 2021, 88 patients who underwent simultaneous carotid revascularization combined with CABG under the same anesthesia in Beijing Anzhen Hospital were retrospectively analyzed, and this study included 25 patients who underwent CAS–CABG and 63 patients who underwent CEA–CABG. The main outcomes included all-cause death, stroke, myocardial infarction and combined adverse events. The main outcomes of the two groups were compared at 30 days after the operation and the mid-term follow-up. Univariate and multivariate Cox proportional hazards regression analyses were performed to determine the independent risk factors affecting mid-term mortality.ResultsWithin 30 days after the operation, there was no significant difference in combined adverse events between the two groups (P = 0.88). During the median follow-up period of 6.69 years (IQR, 5.82–7.57 years), 9 patients (14.30%) in the combined CEA–CABG group died, while 1 patient (4.00%) in the combined CAS–CABG group died. There were no significant differences in mid-term death (P = 0.20), stroke (P = 0.78), myocardial infarction (P = 0.88), or combined adverse events (P = 0.62) between the two groups. Univariate and multivariate Cox proportional hazards regression showed that NYHA grade IV (HR 5.01, 95% CI 1.16–21.64, P = 0.03) and previous myocardial infarction (HR 5.43, 95% CI 1.01–29.29, p = 0.04) were independent risk factors for mid-term mortality. We also found that combined CEA–CABG surgery may be associated with a higher risk of death (HR, 13.15; 95% CI 1.10–157.69, p = 0.04).ConclusionsCombined CAS–CABG is a safe and effective treatment for patients with coronary heart disease complicated with severe carotid stenosis. NYHA grade IV and previous MI were independent risk factors for mid-term mortality.

【 授权许可】

CC BY   
© The Author(s) 2022

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