Podolecka Ewa, Wańha Wojciech, Michalewska-Włudarczyk Aleksandra, Włudarczyk Witold, Bachowski Ryszard, Deja Marek, Kaźmierski Maciej
Kardiol Pol. 2014;72(10):954-9. doi: 10.5603/KP.a2014.0113.
Occurrence of a stroke is a major concern in patients undergoing coronary artery bypass grafting (CABG). It remains uncertain whether significant asymptomatic carotid artery stenosis (CAS) is associated with stroke incidence in such patients.
To investigate the incidence of cerebrovascular events, myocardial infarction (MI), and death in patients with a significant asymptomatic CAS undergoing CABG.
We prospectively evaluated 123 consecutive patients with documented carotid artery duplex Doppler ultrasound examination who underwent isolated CABG. Patients with a significant (≥ 60%) asymptomatic unilateral CAS (n = 35) were compared with those without a significant CAS (n = 88) to assess the rates of stroke, MI and mortality after CABG.
No significant differences between patients with a significant asymptomatic unilateral CAS and those without a significant CAS in regard to age (p = 0.5955), presence of hypertension (p = 0.2343), diabetes (p = 0.5495), smoking (p = 0.7891), serum creatinine (p = 0.47) and left ventricular systolic function as evaluated by ejection fraction (p = 0.3789). No cerebrovascular events, MI and deaths occurred during the first 30 days postoperatively. At 12 months, no differences were seen between the groups in the incidence of MI (p = 0.1005) and mortality (p = 0.3959). However, a trend towards higher stroke incidence was noted among patients with a significant asymptomatic unilateral CAS (p = 0.0692). The primary combined endpoint (stroke, MI, and mortality) occurred in 40% of patients with a significant asymptomatic unilateral CAS and 17.05% of patients without a significant CAS (p = 0.0097). Linear regression analysis showed an association between significant asymptomatic unilateral CAS and stroke (p = 0.0041), and between significant asymptomatic unilateral CAS and the primary end point (p = 0.0475).
The presence of a significant asymptomatic unilateral CAS does not increase the risk of stroke, MI and mortality within 30 days after CABG but is was associated with an increased risk of cardiovascular events during the first 12 months postoperatively.
中风的发生是接受冠状动脉旁路移植术（CABG）患者的主要担忧。在这类患者中，严重无症状颈动脉狭窄（CAS）是否与中风发生率相关仍不确定。
调查接受CABG的严重无症状CAS患者的脑血管事件、心肌梗死（MI）和死亡的发生率。
我们前瞻性评估了123例连续接受单独CABG且有颈动脉双功多普勒超声检查记录的患者。将严重（≥60%）无症状单侧CAS患者（n = 35）与无严重CAS患者（n = 88）进行比较，以评估CABG术后的中风、MI和死亡率。
严重无症状单侧CAS患者与无严重CAS患者在年龄（p = 0.5955）、高血压（p = 0.2343）、糖尿病（p = 0.5495）、吸烟（p = 0.7891）、血清肌酐（p = 0.47）以及通过射血分数评估的左心室收缩功能（p = 0.3789）方面无显著差异。术后30天内未发生脑血管事件、MI和死亡。在12个月时，两组在MI发生率（p = 0.1005）和死亡率（p = 0.3959）方面无差异。然而，在严重无症状单侧CAS患者中观察到中风发生率有升高趋势（p = 0.0692）。主要联合终点（中风、MI和死亡）在40%的严重无症状单侧CAS患者和17.05%的无严重CAS患者中出现（p = 0.0097）。线性回归分析显示严重无症状单侧CAS与中风之间存在关联（p = 0.00
