Nwakanma Lois, Poonyagariyagorn Hataya Kristy, Bello Ricardo, Khoynezhad Ali, Smego Douglas, Plestis Konstadinos A
Department of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Interact Cardiovasc Thorac Surg. 2006 Apr;5(2):159-65. doi: 10.1510/icvts.2005.114678. Epub 2006 Jan 23.
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.
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.
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).
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.
冠心病合并颈动脉疾病患者的最佳治疗方案仍存在争议。本研究分析了同期行颈动脉内膜切除术（CEA）和冠状动脉旁路移植术（CABG）与单纯行CABG的疗效差异。
我们回顾了1999年8月至2003年10月期间412例行CEA/CABG联合手术或单纯CABG手术患者的早期和晚期随访数据。所有接受CEA手术的患者至少有一侧颈动脉狭窄80%。收集术前、术中和术后早期变量的数据。晚期随访数据（术后1.1至69.5个月，平均42.4个月，中位数42.7个月）包括心肌梗死（MI）、中风和死亡情况。对两组间的差异进行了研究。进行单因素和多因素分析以确定整个研究组中死亡、MI和中风的预测因素。
CEA/CABG组有27例患者（6.6%），单纯CABG组有385例患者。CEA/CABG组有1例患者（3.7%）发生围手术期中风，而CABG组有6例（1.6%）（P=0.38）。两组均未根据心电图和肌酸激酶同工酶（CK-MB）标准记录到术后心肌梗死。CEA/CABG组无死亡病例，CABG组有3例死亡（P=1.00）。在随访期内，CEA/CABG组有2例患者（7.4%）发生中风，CABG组有7例患者（2.3%）发生中风（P=0.16）。CEA/CABG组有3例患者（11.1%）发生MI，CABG组有19例患者（6.1%）发生MI（P=0.40）。CEA/CABG组有4例患者（14.8%）死亡，CABG组有51例患者（13.4%）死亡（P=0.77）。两组在60个月时无死亡（所有P>0.05）、无中风和无心肌梗死的生存率无统计学差异。
在我们的患者群体中，与单纯CABG相比，CABG联合CEA并未增加短期和长期的发病率和死亡率。CEA/CABG联合手术可在这类高危患者中安全进行。需要进行前瞻性随机研究以进一步证实这些发现。
