Balaj Ilir, Jakob Heinz, Haddad Ali, Mourad Fanar, Haneya Assad, Ali Ebrahim, Ryadi Noura, Thielmann Matthias, Ruhparwar Arjang, Shehada Sharaf-Eldin
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany.
J Cardiovasc Dev Dis. 2023 Mar 7;10(3):112. doi: 10.3390/jcdd10030112.
-Coronary endarterectomy (CEA) has been introduced to allow revascularization in end-stage coronary artery disease (CAD). After CEA, the injured remnants of the vessel's media could result in fast neo intimal tissue ingrowth, which require an anti-proliferation agent (antiplatelet therapy (APT). We aimed to review outcomes of patients undergoing CEA within bypass surgery who received either single-APT (SAPT) or dual-APT (DAPT). -We retrospectively evaluated 353 consecutive patients undergoing CEA within isolated coronary artery bypass grafting (CABG) in the period 01/2000-07/2019. After surgery, patients received either SAPT (n = 153), or DAPT (n = 200) for six months then lifelong SAPT. Endpoints included early, late survival, and freedom from major-adverse-cardiac and cerebrovascular events (MACCE), which were defined as incidence of stroke, myocardial infarction, need for coronary intervention (PCI or CABG) or death for any cause. -Patients' mean age was 67 ± 9.3 years; they were predominantly male 88.1%. Both DAPT- and SAPT-groups had the same extent of CAD (mean SYNTAX-Score-II: 34.1 ± 11.6 vs. 34.4 ± 17.2, = 0.91). Postoperatively, no difference between DAPT- and SAPT-groups was reported in the incidence of low-cardiac-output syndrome (5% vs. 9.8%, = 0.16), revision for bleeding (5% vs. 6.5% = 0.64), 30-day mortality (4.5% vs. 5.2%, = 0.8) or MACCE (7.5% vs. 11.8%, = 0.19). Imaging follow-up reported significantly higher CEA and total grafts patency (90% vs. 81.5% and 95% vs. 81%, = 0.017) in DAPT patients. Late outcomes within 97.4 ± 67.4 months show lower incidence of overall mortality (19 vs. 51%, < 0.001) and MACCE (24.5 vs. 58.2%, < 0.001) in the DAPT patients when compared with SAPT patients. -Coronary endarterectomy allows revascularization in end-stage CAD when the myocardium is still viable. The use of dual APT after CEA for at least six months seems to improve mid-to-long-term patency rates and survival, and reduced the incidence of major adverse cardiac and cerebrovascular events.
-冠状动脉内膜切除术（CEA）已被用于终末期冠状动脉疾病（CAD）的血运重建。CEA术后，血管中膜的受损残余部分可能导致新生内膜组织快速向内生长，这需要使用抗增殖药物（抗血小板治疗（APT））。我们旨在回顾在搭桥手术中接受单药抗血小板治疗（SAPT）或双联抗血小板治疗（DAPT）的CEA患者的预后。
-我们回顾性评估了2000年1月至2019年7月期间在单纯冠状动脉旁路移植术（CABG）中连续接受CEA的353例患者。术后，患者接受SAPT（n = 153）或DAPT（n = 200）治疗6个月，然后终身接受SAPT。观察终点包括早期、晚期生存率，以及无重大不良心脑血管事件（MACCE），MACCE定义为中风、心肌梗死、冠状动脉介入治疗（PCI或CABG）需求或任何原因导致的死亡发生率。
-患者的平均年龄为67±9.3岁；男性占比88.1%。DAPT组和SAPT组的CAD严重程度相同（平均SYNTAX评分II：34.1±11.6 vs. 34.4±17.2，P = 0.91）。术后，DAPT组和SAPT组在低心排血量综合征发生率（5% vs. 9.8%，P = 0.16）、出血修正率（5% vs. 6.5%，P = 0.64）、30天死亡率（4.5% vs. 5.2%，P = 0.8）或MACCE（7.5% vs. 11.8%，P = 0.19）方面均无差异。影像学随访报告显示，DAPT组患者的CEA和总移植血管通畅率显著更高（90% vs. 81.5%和95% vs. 81%，P = 0.017）。在97.4±67.4个月的晚期预后中，与SAPT组患者相比，DAPT组患者的总死亡率（19% vs. 51%，P < 0.001）和MACCE（24.5% vs. 58.2%，P < 0.001）发生率更低。
-当心肌仍有活力时，冠状动脉内膜切除术可实现终末期CAD的血运重建。CEA术后使用双联抗血小板治疗至少6个月似乎可提高中长期通畅率和生存率，并降低重大不良心脑血管事件的发生率。
