Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Germany (S.C.K., H.J., A.R.).
Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany (T.H.).
Stroke. 2022 Nov;53(11):3270-3277. doi: 10.1161/STROKEAHA.121.037493. Epub 2022 Sep 9.
In patients with coronary artery disease and concomitant asymptomatic severe carotid stenosis, combined simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) has been widely performed despite lack of evidence from randomized trials. We recently showed that the risk of stroke or death within 30 days was higher following CABG+CEA compared with CABG alone. Here, we report long-term outcomes following CABG with versus without CEA.
The CABACS (Coronary Artery Bypass Graft Surgery in Patients With Asymptomatic Carotid Stenosis Study) is a randomized, controlled, multicenter, open trial. Patients with asymptomatic severe (≥70%) carotid stenosis undergoing CABG were allocated either CABG+CEA or CABG alone, and follow-up was 5 years. Major secondary end points included nonfatal stroke or death, any death and any nonfatal stroke. Due to low recruitment, the study was stopped prematurely after randomization of 127 patients in 17 centers.
By 5 years, the rate of stroke or death did not significantly differ between groups (CABG+CEA 40.6% [95% CI, 0.285-0.536], CABG alone 35.0% [95% CI, 0.231-0.484]; =0.58). Higher albeit statistically nonsignificant rates of nonfatal strokes occurred at any time following CABG+CEA versus CABG alone (1 year: 19.3% versus 7.1%, =0.09; 5 years: 29.4% versus 18.8%, =0.25). All-cause mortality up to 5 years was similar in both groups (CABG+CEA: 25.4% versus CABG alone: 23.3%, hazard ratio, 1.148 [95% CI, 0.560-2.353]; =0.71). Subgroup analyses did not reveal any significant effect of age, sex, preoperative modified Rankin Scale and center on outcome events.
During 5-years follow-up, combined simultaneous CABG+CEA was associated with a higher albeit statistically nonsignificant rate of stroke or death compared with CABG alone. This was mainly due to a nonsignificantly higher perioperative risk following CABG+CEA. Since the power of our study was not sufficient, no significant effect of either procedure could be observed at any time during follow-up.
URL: http://www.controlled-trials.com; Unique identifier: ISRCTN13486906.
在伴有无症状性严重颈动脉狭窄的冠状动脉疾病患者中，尽管随机试验缺乏证据，但联合同时进行冠状动脉旁路移植术（CABG）和颈动脉内膜切除术（CEA）已被广泛应用。我们最近表明，与单独 CABG 相比，CABG+CEA 术后 30 天内发生中风或死亡的风险更高。在此，我们报告了 CABG 联合与不联合 CEA 的长期结果。
CABACS（无症状性颈动脉狭窄患者冠状动脉旁路移植术研究）是一项随机、对照、多中心、开放性试验。接受 CABG 的无症状性严重（≥70%）颈动脉狭窄患者被分配接受 CABG+CEA 或单独 CABG 治疗，随访 5 年。主要次要终点包括非致死性中风或死亡、任何死亡和任何非致死性中风。由于招募人数较少，该研究在 17 个中心随机分配了 127 名患者后提前终止。
5 年内，两组之间中风或死亡的发生率无显著差异（CABG+CEA 组为 40.6%[95%CI，0.285-0.536]，单独 CABG 组为 35.0%[95%CI，0.231-0.484]；=0.58）。与单独 CABG 相比，CABG+CEA 组任何时候发生非致死性中风的发生率虽较高但无统计学意义（1 年：19.3%比 7.1%，=0.09；5 年：29.4%比 18.8%，=0.25）。两组 5 年内全因死亡率相似（CABG+CEA 组：25.4%比单独 CABG 组：23.3%，风险比 1.148[95%CI，0.560-2.353]；=0.71）。亚组分析未发现年龄、性别、术前改良 Rankin 量表和中心对结局事件有任何显著影响。
在 5 年随访期间，与单独 CABG 相比，联合同时进行 CABG+CEA 与中风或死亡发生率较高（尽管无统计学意义）相关。这主要是由于 CABG+CEA 术后围手术期风险较高。由于我们的研究效能不足，在随访期间任何时候都无法观察到任何一种手术的显著效果。
