Borioni Raoul, Nardi Paolo, Garofalo Mariano, Silvano Andrea, Albano Paolo, Dionisi Paolo, Chiariello Luigi
Cattedra di Cardiochirurgia, Università degli Studi Tor Vergata, European Hospital, Roma.
Ital Heart J Suppl. 2004 Jul;5(7):534-8.
The aim of this study was to evaluate the incidence of late cardiac events in patients submitted to carotid endarterectomy (CEA), asymptomatic for coronary artery disease during the carotid surgical procedure.
During a period of 11 years, 162 patients (122 males, 40 females, mean age 68 +/- 12 years), asymptomatic for coronary artery disease and/or without sings of coronary artery disease at the cardiological screening, were submitted to CEA for symptomatic or severe (> or = 70%) carotid stenoses. Clinical follow-up was performed on 151 patients (93%), to identify the incidence of cardiac and neurological events and freedom from late death. The results of this group of patients (group A) were compared to those obtained during follow-up of 147 patients (133 males, 14 females, mean age 69 +/- 15 years) (group B) affected by coronary artery disease and submitted to combined CEA and coronary artery bypass grafting (CABG).
During follow-up, in group A freedom from late death, cardiac death and adverse neurological events were 77 +/- 4.8, 86 +/- 4.4 and 87.3 +/- 4.5% at 9 years, respectively. Freedom from adverse neurological events in group A was similar to that registered in group B (86.4 +/- 5.6%, p = NS). The incidence of cumulative cardiac events and fatal cardiac events (myocardial infarction, sudden death, congestive heart failure) on the contrary, was higher in group A than in group B (13.2 vs 6.8%, p = 0.0424, and 7.9 vs 3.4%, p = 0.0446, respectively).
In patients submitted to isolated CEA, although without symptoms or signs of coronary artery disease at the timing of the carotid procedure, the possibility of a severe coronary disease development during follow-up is not negligible: the incidence of late cardiac events may be higher than in patients with coronary artery disease corrected at the same time of the CEA procedure. These data suggest the opportunity of a systematic cardiological screening during follow-up in patients submitted to isolated CEA, although clinically asymptomatic for coronary artery disease at the timing of the vascular procedure, to improve the long-term survival.
本研究旨在评估在颈动脉内膜切除术（CEA）过程中无冠心病症状的患者发生晚期心脏事件的发生率。
在11年的时间里，162例患者（122例男性，40例女性，平均年龄68±12岁），在心脏检查中无冠心病症状和/或无冠心病体征，因有症状或严重（≥70%）颈动脉狭窄接受CEA手术。对151例患者（93%）进行了临床随访，以确定心脏和神经事件的发生率以及无晚期死亡情况。将这组患者（A组）的结果与147例（133例男性，14例女性，平均年龄69±15岁）受冠心病影响且接受CEA和冠状动脉旁路移植术（CABG）联合手术的患者（B组）随访期间获得的结果进行比较。
随访期间，A组9年时无晚期死亡、心源性死亡和不良神经事件的比例分别为77±4.8%、86±4.4%和87.3±4.5%。A组不良神经事件的发生率与B组记录的发生率相似（86.4±5.6%，p=无显著性差异）。相反，A组累积心脏事件和致命心脏事件（心肌梗死、猝死、充血性心力衰竭）的发生率高于B组（分别为13.2%对6.8%，p=0.0424；7.9%对3.4%，p=0.0446）。
在接受单纯CEA手术的患者中，尽管在颈动脉手术时没有冠心病症状或体征，但随访期间发生严重冠心病的可能性不可忽视：晚期心脏事件的发生率可能高于同期接受CEA手术且冠心病得到纠正的患者。这些数据表明，对于接受单纯CEA手术的患者，尽管在血管手术时临床上无冠心病症状，但在随访期间进行系统的心脏检查以提高长期生存率是有必要的。
