Long-term results of isolated coronary artery bypass surgery in patients with concomitant carotid artery stenosis

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Objective. To analyze long-term mortality, incidence of cerebral and cardiac events after isolated coronary bypass grafting (CABG) in patients with concomitant lesions of coronary and carotid arteries, to determine the factors associated with long-term mortality. Material and methods. There were 249 patients (mean age 64±6.5 years, male-to-female ratio 188/61). All ones had multiple-vessel coronary artery disease and stenosis of at least one internal carotid artery ≥50% and underwent isolated CABG in 2010—2019. In 130 patients, ICA stenosis was 50—60%, in 84 patients — 65—70%, in 27 — >70%, in 8 — ICA occlusion. All patients received aspirin, statins and β-blockers after CABG. Overall and cardiac mortality, incidence of cerebral and cardiac events were assessed in long-term period. The median follow-up was 76 [56; 112] months. Pre-, intra- and postoperative factors (n=28) were studied as potential predictors of overall mortality. Results. All-cause long-term mortality was 13.2% (33/249), cardiac mortality — 6.8% (17/249). Delayed cerebral events developed in 17 (6.8%) patients: 3 ones had transient ischemic attack on the side of lesion in 3, 5 and 7 years after surgery, 14 ones had stroke (unilateral in 12 cases within 1-9 years, 2 cases were fatal). The next cardiac events were registered throughout the follow-up period: angina recurrence — in 46 (18.5%), myocardial infarction (MI) — in 5 (2.0%). Fifteen (6.0%) patients underwent percutaneous coronary interventions, and other ones received medicines. Univariate analysis revealed the following factors associated with long-term overall mortality: chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) <40% (odds ratio (OR) 4.1; 95% confidence interval (CI) 1.4—12.1; p=0.015), postoperative atrial fibrillation (AF) (OR 2.7; 95% CI 1.2—5.9; p=0.012) and previous MI (OR 2.3; 95% CI 1.1—5.2; p=0.031). Multivariate analysis confirmed the effect of CHF with LVEF <40% (OR 8.7; 95% CI 1.1—69.4; p=0.041) and AF in postoperative period (OR 2.4; 95% CI 1.0—5.9; p=0.049), as well as revealed another factor affecting long-term overall mortality, i.e. chronic obstructive pulmonary disease (COPD) (OR 2.8; 95% CI 1.0—7.7; p=0.045). Conclusion. In patients with multiple-vessel coronary and carotid lesions undergoing isolated CABG, all-cause long-term mortality was 13.2% (33/249). Incidence of delayed cerebral events (6.8%) and their predominant unilateral nature indicate the need for careful cerebrovascular monitoring after CABG. CHF with LVEF <40%, postoperative AF, previous MI and COPD are associated with higher all-cause long-term mortality.

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