Dong Hui, Che Wuqiang, Jiang Xiongjing, Peng Meng, Zou Yubao, Xiong Hongliang, Chen Yang, Xu Bo, Yang Yuejin, Gao Runlin
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Catheter Cardiovasc Interv. 2018 Feb 15;91(S1):632-638. doi: 10.1002/ccd.27486. Epub 2018 Jan 22.
The purpose of this study was to evaluate 1-year results and influencing factors of carotid artery stenting (CAS) before open heart surgery (OHS).
Currently, the clinical outcomes and influencing factors of CAS followed by OHS still remain controversial.
Three hundred twenty-three consecutive patients scheduled for CAS and OHS were enrolled in this study. The primary endpoint was a composite of major stroke, myocardial infarction, or death within 1 year after CAS.
The incidence of the primary endpoint was 5.6% (18/323). The Cox regression analysis revealed that an interval of ≤5 days between CAS and OHS (HR, 4.85, 95% CI, 1.87-12.58; P = 0.001), congestive heart failure (HR, 4.08, 95% CI, 1.45-11.51; P = 0.008), and renal insufficiency (HR, 4.56, 95% CI, 1.28-16.32; P = 0.020) could independently predict the incidence of the primary endpoint. The rate of the primary endpoint from CAS to 30 days after OHS was 4.6% (15/323). An interval of ≤5 days between CAS and OHS (OR, 4.51, 95% CI, 1.52-13.36; P = 0.007) and congestive heart failure (OR, 5.32, 95% CI, 1.63-17.43; P = 0.006) were identified as independent risk factors for the primary endpoint rate from CAS to 30 days after OHS by logistic regression analysis.
CAS followed by OHS is a safe and effective treatment for patients with concomitant carotid and cardiac disease within 1-year follow up. The interval between CAS and OHS, congestive heart failure, and renal insufficiency could obviously influence the 1-year results.
本研究旨在评估心脏直视手术（OHS）前进行颈动脉支架置入术（CAS）的1年结果及影响因素。
目前，OHS后行CAS的临床结局及影响因素仍存在争议。
本研究纳入了323例连续计划行CAS及OHS的患者。主要终点为CAS后1年内发生的主要卒中、心肌梗死或死亡的复合事件。
主要终点的发生率为5.6%（18/323）。Cox回归分析显示，CAS与OHS之间的间隔≤5天（HR，4.85，95%CI，1.87 - 12.58；P = 0.001）、充血性心力衰竭（HR，4.08，95%CI，1.45 - 11.51；P = 0.008）和肾功能不全（HR，4.56，95%CI，1.28 - 16.32；P = 0.020）可独立预测主要终点的发生率。从CAS至OHS后30天主要终点的发生率为4.6%（15/323）。通过逻辑回归分析确定，CAS与OHS之间的间隔≤5天（OR，4.51，95%CI，1.52 - 13.36；P = 0.007）和充血性心力衰竭（OR，5.32，95%CI，1.63 - 17.43；P = 0.006）是从CAS至OHS后30天主要终点发生率的独立危险因素。
OHS前先行CAS在1年随访期内对合并颈动脉和心脏疾病的患者是一种安全有效的治疗方法。CAS与OHS之间的间隔、充血性心力衰竭和肾功能不全可明显影响1年结果。
