Combined Coronary Artery Bypass and Carotid Endarterectomy: Long-Term Results
Combined Coronary Artery Bypass and Carotid Endarterectomy: Long-Term Results
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冠状动脉搭桥术和颈动脉内膜切除术联合治疗：长期结果
DOI：
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
F. Seifert
中科院分区：
文献类型：
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作者：
D. Char;S. Cuadra;J. Ricotta;Thomas V. Bilfinge;F. Giron;A. Mclarty;I. Krukenkamp;A. Saltman;F. Seifert
目的：我们确定接受冠状动脉搭桥术和颈动脉内膜切除术（CAB/CEA）联合治疗的患者的晚期生存、晚期卒中的自由和晚期心脏事件的自由。方法：对1994年1月至1999年12月在我院行CAB/CEA的所有患者进行分析。从办公室记录和电话访谈中获得后续数据。终点包括任何原因导致的死亡、中风和非致命性心脏事件（心肌梗死、心力衰竭、经皮腔内血管成形术伴支架植入、重做CAB）。数据以生命表格式表示。结果：在6年的时间里，154例患者合并了CAB/CEA，术后卒中发生率为3.9%。死亡6例（3.9%），随访148例。平均随访38±23个月（1 ~ 82个月）。在随访期间，2名患者（1.4%）发生晚期中风，17名患者（11%）发生晚期非致命性心脏事件。晚期死亡率为13%（19例）。在晚期死亡的人中，4人与心脏病有关，1人与中风有关。Kaplan-Meier分析5年生存率为80±4.3%。在5年时，晚期同侧神经事件的自由度为98±1.3%。晚期心脏事件的自由度为82±4.6%。结论：绝大多数合并冠状动脉和颈动脉疾病的患者预期寿命可超过5年。因此，这些患者应被视为预防性CEA预防卒中的候选人，即使他们的颈动脉病变无症状。成功的CAB/CEA提供了良好的长期生存和晚期心脏事件的自由，以及晚期中风的良好自由。围手术期事件的进一步减少将使这种手术方式对合并疾病的患者更具吸引力。
Purpose: We determined late survival, freedom from late stroke, and freedom from late cardiac events in patients treated by combined coronary artery bypass and carotid endarterectomy (CAB/CEA). Methods: All patients who underwent CAB/CEA in our institution between January 1994 and December 1999 were identified. Follow-up data were obtained from office records and telephone interviews. Endpoints included death from any cause, stroke, and non-fatal cardiac events (MI. CHF, percutaneous transluminal angioplasty with stenting, redo CAB). Data were expressed in life table format. Results: Over a 6-yr period 154 patients had combined CAB/CEA with a 3.9% postoperative stroke rate. Six patients (3.9%) died, leaving 148 patients for follow-up. Average follow-up was 38±23 months (range: 1–82 months). During the follow-up period two patients (1.4%) had late strokes and 17 patients (11%) had late non-fatal cardiac events. The late mortality rate was 13% (19 patients). Of the late mortalities, four were related to cardiac disease and one to stroke. Using Kaplan—Meier analysis, the 5-yr survival probability was 80±4.3%. The freedom from late ipsilateral neurologic events was 98±1.3% at 5 yr. The freedom from late cardiac events was 82±4.6% at 5 yr. Conclusions: The large majority of patients with combined coronary and carotid artery disease can be expected to live for greater than 5 yr. Therefore, these patients should be considered candidates for prophylactic CEA for stroke prevention, even when their carotid lesions are asymptomatic. Successful CAB/CEA provides good long-term survival and freedom from late cardiac events, as well as excellent freedom from late stroke. Further reduction in perioperative events will make this operative approach even more attractive in patients with combined disease.