Division of Cardiothoracic Surgery, University of Illinois at Chicago, 840 South Wood, CSB 417, Chicago, IL 60612, USA.
World J Surg. 2010 Oct;34(10):2292-8. doi: 10.1007/s00268-010-0506-4.
Management of patients with concomitant carotid and coronary artery disease has been controversial. Divergent strategies have been employed, including simultaneous carotid endarterectomy and coronary bypass (SCC) versus various staged procedures. Although no strict comparison group is available, this study defines current outcomes of SCC, compared qualitatively to two reference categories.
Utilizing the STS database from 2003 to 2007, patients who had SCC were compared with patients with cerebrovascular disease who had coronary bypass (CABG) with prior carotid endarterectomy (CEA), and those with carotid Doppler stenosis >75% and no carotid intervention. Logistic regression analysis adjusted for differences in baseline characteristics and operative mortality (OM), and a composite of neurological complications (NC) was assessed.
Of 745,769 patients who underwent isolated CABG with/without CEA, 108,212 (14%) had cerebrovascular disease. Of this group, 5,732 (5%) underwent SCC. The SCC group had more males and lower preoperative risk factors. After statistical adjustment for all baseline differences, SCC had clinically and statistically higher OM and NC compared with any of the reference groups, with 20-40% higher event risk.
Although no quantitative control group exists for comparison, SCC as recently performed in North America has a high risk compared with any of the reference groups. Suboptimal results associated with the SCC strategy suggest a need for quality improvement and research on the optimal management of patients with simultaneous carotid and coronary disease.
同时患有颈动脉和冠状动脉疾病的患者的治疗方案一直存在争议。不同的策略已被采用，包括同时进行颈动脉内膜切除术和冠状动脉旁路移植术（SCC）与各种分期手术。尽管没有严格的对照组可供使用，但本研究通过与两个参考类别进行定性比较，定义了 SCC 的当前结果。
利用 2003 年至 2007 年 STS 数据库，将同时接受 SCC 治疗的患者与因脑血管疾病而先行颈动脉内膜切除术（CEA）后再接受冠状动脉旁路移植术（CABG）的患者以及颈动脉多普勒狭窄>75%但未进行颈动脉介入治疗的患者进行比较。采用逻辑回归分析调整基线特征和手术死亡率（OM）的差异，并评估神经并发症（NC）的综合指标。
在 745769 例单独接受 CABG 加/不加 CEA 的患者中，有 108212 例（14%）患有脑血管疾病。在这一组中，有 5732 例（5%）接受了 SCC。SCC 组男性患者更多，术前危险因素更低。在对所有基线差异进行统计学调整后，SCC 的 OM 和 NC 明显高于任何参考组，风险增加 20%-40%。
尽管没有进行定量比较的对照组，但与任何参考组相比，最近在北美进行的 SCC 风险较高。与 SCC 策略相关的不理想结果表明，需要进行质量改进和研究，以优化同时患有颈动脉和冠状动脉疾病患者的治疗方案。
