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Early and late results of combined carotid endarterectomy and coronary artery bypass versus isolated coronary artery bypass.

Abstract：

OBJECTIVE:Optimal management of patients with combined coronary and carotid artery disease remains controversial. This study analyzed the outcomes between simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) vs. isolated CABG. METHODS:We reviewed the early and late follow-up data of 412 patients who underwent either combined CEA/CABG vs. CABG alone between August 1999 and October 2003. All patients undergoing CEA had at least 80% stenosis of one carotid artery. Data were obtained for pre-, intra-, and early postoperative variables. Late follow-up data (range 1.1 to 69.5 months postoperative, mean 42.4 months, median 42.7 months) included myocardial infarctions (MI), stroke and death. Differences between the two groups were investigated. Univariate and multivariate analysis were carried out to identify predictors of death, MI, and stroke in the entire group. RESULTS:There were 27 patients (6.6%) in the CEA/CABG group and 385 patients in the CABG alone group. There was one patient (3.7%) in the CEA/CABG group who had a perioperative stroke versus six (1.6%) in the CABG group (P=0.38). There were no documented postoperative myocardial infarctions (MI) by EKG and CK-MB criteria in both groups. There were no deaths in the CEA/CABG group versus three in the CABG group (P=1.00). Within the follow-up period, strokes developed in 2 (7.4%) CEA/CABG patients and in 7 (2.3%) CABG patients (P=0.16). Three CEA/CABG patients (11.1%) developed MI versus 19 (6.1%) patients in the CABG group (P=0.40). There were 4 (14.8%) deaths in the CEA/CABG group versus 51 (13.4%) in the CABG group (P=0.77). Freedom from death, stroke, and myocardial infarction was not statistically different between the groups at 60 months (all P>0.05). CONCLUSIONS:The addition of CEA to CABG did not increase short- and long-term morbidity and mortality compared to isolated CABG in our group of patients. Combined CEA/CABG can be performed safely in this high-risk group of patients. Prospective randomized study is needed to further substantiate these findings.

journal_name

Interact Cardiovasc Thorac Surg

journal_title

Interactive cardiovascular and thoracic surgery

authors

Nwakanma L,Poonyagariyagorn HK,Bello R,Khoynezhad A,Smego D,Plestis KA

doi

10.1510/icvts.2005.114678

subject

Has Abstract

pub_date

2006-04-01 00:00:00

pages

159-65

issue

eissn

1569-9293

issn

1569-9285

pii

icvts.2005.114678

journal_volume

pub_type

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Early and late results of combined carotid endarterectomy and coronary artery bypass versus isolated coronary artery bypass.