颈动脉双功能超声筛查与冠状动脉旁路移植术后患者的卒中及死亡率的相关性。
Association of carotid duplex ultrasonography screening with stroke and mortality among patients undergoing coronary artery bypass grafting.
机构信息
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiac Surgery, Fujian Children's Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People's Republic of China.
出版信息
J Vasc Surg. 2024 Jul;80(1):153-162.e4. doi: 10.1016/j.jvs.2024.02.039. Epub 2024 Mar 7.
OBJECTIVE
Selection criteria for carotid duplex ultrasonography screening (DUS) before coronary artery bypass grafting (CABG) is primarily based on limited observational analysis, and the risks associated with carotid artery stenosis (CAS) detected by this approach to preoperative DUS are uncertain. This study aimed to determine the association of carotid DUS with stroke and mortality among patients undergoing CABG.
METHODS
Adult patients with coronary artery disease who underwent isolated CABG or CABG with concomitant valvular or congenital procedure were identified. CHADS-VASc score was assessed before CABG, and patients were recorded as high risk if they had a score of 3 or higher. The primary outcomes were stroke and all-cause mortality. Secondary outcomes included ischemic stroke, non-ischemic stroke, transient ischemic attack, and cardiovascular mortality.
RESULTS
Among 8958 patients who underwent CABG, 70.9% (n = 6347) received carotid DUS preoperatively (low-risk, 57.3%; high-risk, 42.7%). In the low-risk cohort, there was no significant difference in the risk of stroke (20.7 per 1000 patient-years for CAS vs 13.1 per 1000 patient-years for no CAS; adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 0.78-1.68) or mortality (20.5 per 1000 patient-years for CAS vs 16.8 per 1000 patient-years for no CAS; aHR, 1.33; 95% CI, 0.97-1.83) at 15 years. In the high-risk cohort, CAS was associated with significantly higher risks of stroke at 30 days (433.2 vs 279.5 per 1000 patient-years; aHR, 1.92; 95% CI, 1.00-3.70) and mortality at 15 years (38.4 vs 32.7 per 1000 patient-years; aHR, 1.25; 95% CI, 1.01-1.57) compared with no CAS.
CONCLUSIONS
CAS did not impact the incidence of stroke or mortality in the low-risk cohort who underwent CABG. However, in the high-risk cohort, CAS was associated with a significant increase in the risks of 30-day stroke and 15-year mortality, indicating selective carotid DUS is necessarily recommended for these patients.
目的
颈动脉双功能超声检查（DUS）在冠状动脉旁路移植术（CABG）前的选择标准主要基于有限的观察性分析，并且通过这种方法检测到的颈动脉狭窄（CAS）与术前 DUS 相关的风险尚不确定。本研究旨在确定颈动脉 DUS 与 CABG 患者中风和死亡率之间的关系。
方法
确定了接受单纯 CABG 或 CABG 联合瓣膜或先天性手术的冠状动脉疾病成年患者。在 CABG 前评估 CHADS-VASc 评分，如果评分达到 3 或更高，则将患者记录为高危。主要结局是中风和全因死亡率。次要结局包括缺血性中风、非缺血性中风、短暂性脑缺血发作和心血管死亡率。
结果
在 8958 例接受 CABG 的患者中，70.9%（n=6347）术前接受了颈动脉 DUS（低危，57.3%；高危，42.7%）。在低危组中，CAS 组的中风风险无显著差异（CAS 患者每 1000 例患者年 20.7 例，无 CAS 患者每 1000 例患者年 13.1 例；调整后的危险比[aHR]，1.14；95%置信区间[CI]，0.78-1.68）或死亡率（CAS 患者每 1000 例患者年 20.5 例，无 CAS 患者每 1000 例患者年 16.8 例；aHR，1.33；95%CI，0.97-1.83）在 15 年内。在高危组中，CAS 与 30 天的中风风险显著相关（433.2 与 279.5 例/每 1000 例患者年；aHR，1.92；95%CI，1.00-3.70）和 15 年死亡率（38.4 与 32.7 例/每 1000 例患者年；aHR，1.25；95%CI，1.01-1.57）与无 CAS 相比。
结论
CAS 并未降低接受 CABG 的低危患者中风或死亡率的发生率。然而，在高危组中，CAS 与 30 天中风和 15 年死亡率的风险显著增加相关，表明选择性颈动脉 DUS 对这些患者是必要的。
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