Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Ann Vasc Surg. 2022 Oct;86:428-439. doi: 10.1016/j.avsg.2022.05.027. Epub 2022 Jun 11.
There are several treatment options for patients with concomitant carotid and coronary artery disease, and it is difficult to identify an optimal treatment strategy that has consensus. Here, we performed a meta-analysis to compare the early and long-term outcomes of staged and synchronous carotid endarterectomy and coronary artery bypass grafting approaches.
We performed a meta-analysis that compared staged and synchronous carotid endarterectomy and coronary artery bypass grafting approaches between July 1976 and September 2021. PubMed, EMBASE, and the Cochrane Library were systematically searched for related articles.
Nineteen studies were identified with a total of 39,269 and 30,066 patients in the synchronous and staged groups, respectively. Early mortality was lower in the staged group than in the synchronous group (odds ratio OR 1.256, 95% confidence interval CI 1.006-1.569, P= P < 0.05, I = 54.5%), and stroke rates were significantly higher in the synchronous group (OR 1.356, 95% CI 1.232-1.493, P < 0.05, I = 33.3%). The rate of myocardial ischemia was significantly higher in the staged group than in the synchronous group (OR 0.757, 95% CI 0.635-0.903, P < 0.05, I = 51.5%), and this meta-analysis also showed a significantly higher risk of transient ischemic attacks (TIAs) in the synchronous group (OR 1.335, 95% CI 1.055-1.688, P < 0.05, I = 0.00%). The secondary outcomes, including the rate of reoperation, were significantly lower for the staged procedure than for the synchronous procedure (OR 1.177, 95% CI 1.052-1.318, P < 0.05, I = 4.2%), and the rate of wound infection was significantly higher in the synchronous group than in the staged group (OR 0.457, 95% CI 0.403-0.519, P < 0.05, I = 0.0%). There was no significant difference in the rate of cardiac arrhythmia between the two groups (OR 0.544, 95% CI 0.265-1.117, P > 0.05, I = 12.7%). There was also no statistical significance in the long-term results regarding the incidence of stroke, myocardial ischemia, and mortality between the synchronous and staged groups (P > 0.05).
Patients treated with the synchronous approach had a significantly higher risk of early mortality, stroke, TIA, wound infection, and reoperation and a lower risk of myocardial ischemia than those treated with the staged approach. There was no significant difference in the long-term results between the 2 groups.
对于同时患有颈动脉和冠状动脉疾病的患者，有几种治疗选择，难以确定具有共识的最佳治疗策略。在这里，我们进行了一项荟萃分析，以比较分期和同期颈动脉内膜切除术和冠状动脉旁路移植术的早期和长期结果。
我们进行了一项荟萃分析，比较了 1976 年 7 月至 2021 年 9 月期间分期和同期颈动脉内膜切除术和冠状动脉旁路移植术的方法。系统地检索了 PubMed、EMBASE 和 Cochrane 图书馆中相关的文章。
共确定了 19 项研究，同期组和分期组分别有 39269 例和 30066 例患者。分期组的早期死亡率低于同期组（比值比 OR 1.256，95%置信区间 CI 1.006-1.569，P=0.05，I=54.5%），同期组的中风发生率明显更高（OR 1.356，95%置信区间 CI 1.232-1.493，P0.05，I=33.3%）。分期组心肌缺血的发生率明显高于同期组（OR 0.757，95%置信区间 CI 0.635-0.903，P0.05，I=51.5%），并且该荟萃分析还显示同期组短暂性脑缺血发作（TIA）的风险明显更高（OR 1.335，95%置信区间 CI 1.055-1.688，P0.05，I=0.00%）。次要结局，包括再次手术率，分期手术明显低于同期手术（OR 1.177，95%置信区间 CI 1.052-1.318，P0.05，I=4.2%），同期组的伤口感染发生率明显高于分期组（OR 0.457，95%置信区间 CI 0.403-0.519，P0.05，I=0.0%）。两组之间的心律失常发生率没有显著差异（OR 0.544，95%置信区间 CI 0.265-1.117，P0.05，I=12.7%）。同期组和分期组之间的长期结果，包括中风、心肌缺血和死亡率，也没有统计学意义（P0.05）。
同期治疗组的早期死亡率、中风、TIA、伤口感染和再次手术风险明显高于分期治疗组，而心肌缺血风险较低。两组的长期结果无显著差异。
