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Midterm outcomes of simultaneous carotid revascularization combined with coronary artery bypass grafting
Songhao Jia1, Maozhou Wang1, Ming Gong2
1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
Insights
Simultaneous carotid artery stenting (CAS) combined with coronary artery bypass grafting (CABG) offers a safe and effective treatment option for patients with severe carotid stenosis and coronary heart disease. This approach shows comparable mid-term outcomes to carotid endarterectomy (CEA) combined with CABG.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) is a common procedure for patients with concurrent coronary heart disease and severe carotid stenosis.
- Carotid artery stenting (CAS) has emerged as a viable alternative to CEA in recent years.
Purpose of the Study:
- To compare the early and mid-term outcomes of simultaneous CAS-CABG versus CEA-CABG in patients with coronary heart disease and severe carotid stenosis.
- To identify independent risk factors for mid-term mortality in this patient population.
Main Methods:
- Retrospective analysis of 88 patients undergoing simultaneous carotid revascularization (CAS or CEA) with CABG from January 2011 to January 2021.
- Comparison of outcomes at 30 days and mid-term follow-up (median 6.69 years) between the CAS-CABG (n=25) and CEA-CABG (n=63) groups.
- Univariate and multivariate Cox proportional hazards regression analyses to determine risk factors for mid-term mortality.
Main Results:
- No significant difference in combined adverse events within 30 days post-operation between the CAS-CABG and CEA-CABG groups.
- During mid-term follow-up, the CAS-CABG group had one death (4.00%) compared to nine deaths (14.30%) in the CEA-CABG group, though this difference was not statistically significant (P=0.20).
- NYHA grade IV and previous myocardial infarction were identified as independent risk factors for mid-term mortality. Combined CEA-CABG surgery was associated with a higher risk of death (HR 13.15, P=0.04).
Conclusions:
- Simultaneous CAS-CABG is a safe and effective treatment for patients with coronary heart disease and severe carotid stenosis.
- NYHA grade IV and prior myocardial infarction are independent risk factors for mid-term mortality.
- Combined CEA-CABG may be associated with an increased risk of death compared to CAS-CABG.
Background:
Simultaneous 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.
Methods:
From 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.
Results:
Within 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).
Conclusions:
Combined 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.
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