Original Article
Early results following synchronous coronary artery bypass grafting and carotid endarterectomy: a propensity score matched comparison with solely carotid endarterectomy
Abstract
Background: The optimal management for patients with concomitant severe coronary artery disease (CAD) and carotid artery stenosis (CAS) remains controversial.
Methods: One hundred and two solely carotid endarterectomy (CEA) patients were matched to 34 synchronous CEA and coronary artery bypass grafting (CABG) patients according to the propensity score during 7 years. We retrospectively analyzed the baseline characteristics and 30-day results of both groups.
Results: The two groups were similar with regard to age, sex, the degree of CAS, the incidence of hypertension, diabetes mellitus (DM), smoking, hyperlipidemia and symptomatic CAS. Higher incidence of contralateral >70% CAS occurred in synchronous CEA/CABG group (29.4% vs. 13.7%, P=0.038). More CAD was present in synchronous CEA/CABG group (12.7% vs. 100%, P<0.001). The left ventricular ejection fraction was higher in solely CEA group (0.73±0.26 vs. 0.55±0.09, P<0.001). The Charlson’s Weighted Index of Comorbidities (WIC) was higher in synchronous CEA/CABG group (4.32±1.07 vs. 1.98±1.67, P<0.001). The operation time was 295±49 min for synchronous CEA/CABG and 143±39 min for solely CEA (P<0.001). The intraoperative blood loss was 771±334 mL for synchronous CEA/CABG and 70±54 mL for solely CEA (P<0.001). No death occurred in both groups within 30 days. The cumulative occurrence of primary endpoint [myocardial infarction (MI), stroke and death] was 1 (2.94%) in synchronous CEA/CABG group and 3 (2.94%) in solely CEA group, no statistical difference was found between the two groups (P=1.000). The cumulative occurrence of complications was 11 (32.4%) in synchronous CEA/CABG group compared with 23 (22.6%) in solely CEA group (P=0.169).
Conclusions: Our study suggested that the 30-day mortality and morbidity rate of synchronous CEA/CABG was comparable to solely CEA. Our results add to the controversy of the outcomes of synchronous CEA/CABG procedure. Further prospective randomized controlled trial is needed to definitely evaluate the results of synchronous CEA/CABG.
Methods: One hundred and two solely carotid endarterectomy (CEA) patients were matched to 34 synchronous CEA and coronary artery bypass grafting (CABG) patients according to the propensity score during 7 years. We retrospectively analyzed the baseline characteristics and 30-day results of both groups.
Results: The two groups were similar with regard to age, sex, the degree of CAS, the incidence of hypertension, diabetes mellitus (DM), smoking, hyperlipidemia and symptomatic CAS. Higher incidence of contralateral >70% CAS occurred in synchronous CEA/CABG group (29.4% vs. 13.7%, P=0.038). More CAD was present in synchronous CEA/CABG group (12.7% vs. 100%, P<0.001). The left ventricular ejection fraction was higher in solely CEA group (0.73±0.26 vs. 0.55±0.09, P<0.001). The Charlson’s Weighted Index of Comorbidities (WIC) was higher in synchronous CEA/CABG group (4.32±1.07 vs. 1.98±1.67, P<0.001). The operation time was 295±49 min for synchronous CEA/CABG and 143±39 min for solely CEA (P<0.001). The intraoperative blood loss was 771±334 mL for synchronous CEA/CABG and 70±54 mL for solely CEA (P<0.001). No death occurred in both groups within 30 days. The cumulative occurrence of primary endpoint [myocardial infarction (MI), stroke and death] was 1 (2.94%) in synchronous CEA/CABG group and 3 (2.94%) in solely CEA group, no statistical difference was found between the two groups (P=1.000). The cumulative occurrence of complications was 11 (32.4%) in synchronous CEA/CABG group compared with 23 (22.6%) in solely CEA group (P=0.169).
Conclusions: Our study suggested that the 30-day mortality and morbidity rate of synchronous CEA/CABG was comparable to solely CEA. Our results add to the controversy of the outcomes of synchronous CEA/CABG procedure. Further prospective randomized controlled trial is needed to definitely evaluate the results of synchronous CEA/CABG.
