Pölzl Leo, Lohmann Ronja, Sutter Christian, Engler Clemens, Graber Michael, Nägele Felix, Hirsch Jakob, Eder Jonas, Ioannou-Nikolaidou Maria, Lutz Antonia, Hübner Franziska, Noflatscher Maria, Kirchmair Rudolf, Ruttmann Elfriede, Reinstadler Sebastian, Knoflach Michael, Grimm Michael, Bauer Axel, Bonaros Nikolaos, Holfeld Johannes, Gollmann-Tepeköylü C, Theurl Markus
Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
University Hospital of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria.
Open Heart. 2025 Jun 3;12(1):e003311. doi: 10.1136/openhrt-2025-003311.
Perioperative stroke associated with coronary artery bypass grafting (CABG) is a catastrophic event. Identification of patients at risk and reduction of its incidence remains of high importance. The aim of this study was to analyse the association of different degrees of asymptomatic carotid artery stenosis (CAS) with the perioperative outcome in a consecutive series of CABG patients and to identify predictors for CABG associated ischaemic stroke.
In total, 2727 patients undergoing isolated CABG procedure at the Medical University of Innsbruck between 2010 and 2020 were included in this study. Sonography data included the severity of carotid stenosis for left and right internal carotid artery individually. The primary outcome was the 30-day stroke and mortality rate, and the secondary outcome was 5-year mortality. A Cox regression model was performed after adjustment for EuroSCORE II.
Left CAS>50% was present in 177 patients (7%) and right CAS>50% in 197 patients (7.8%). In total, 1.6% (40 patients) of the patients died within 30 days after surgery, and 1.0% (24 patients) experienced a postoperative stroke within 30 days. Patients with a carotid stenosis>90% had a higher 30-day mortality (p<0.001) and higher incidence of postoperative stroke within 30 days (p=0.005). Patients with a history of a prior stroke were at higher risk of experiencing another stroke within 30-days after surgery, with an HR of 6.829 (2.811-16.589) (p<0.001).
Asymptomatic CAS>90% and history of stroke are both independent risk factors for perioperative stroke and 30-day mortality.
冠状动脉旁路移植术（CABG）相关的围手术期卒中是一种灾难性事件。识别高危患者并降低其发生率仍然至关重要。本研究的目的是分析连续系列CABG患者中不同程度的无症状颈动脉狭窄（CAS）与围手术期结局的关联，并确定CABG相关缺血性卒中的预测因素。
本研究纳入了2010年至2020年间在因斯布鲁克医科大学接受单纯CABG手术的2727例患者。超声检查数据包括左右颈内动脉各自的颈动脉狭窄严重程度。主要结局是30天卒中及死亡率，次要结局是5年死亡率。在对欧洲心脏手术风险评估系统II（EuroSCORE II）进行校正后进行Cox回归模型分析。
177例患者（7%）存在左侧CAS>50%，197例患者（7.8%）存在右侧CAS>50%。共有1.6%（40例患者）在术后30天内死亡，1.0%（24例患者）在术后30天内发生卒中。颈动脉狭窄>90%的患者30天死亡率更高（p<0.001），术后30天内卒中发生率更高（p=0.005）。有既往卒中史的患者在术后30天内发生另一次卒中的风险更高，风险比为6.829（2.811-16.589）（p<0.001）。
无症状CAS>90%和卒中史均是围手术期卒中和30天死亡率的独立危险因素。
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