Long-term results of simultaneous carotid endarterectomy and coronary artery bypass grafting: predictors of cardiac events and mortality

Objective. To analyze the long-term outcomes of simultaneous carotid endarterectomy (CEE) and coronary artery bypass grafting (CABG), predictors of mortality and cardiac events. Material and methods. A cohort retrospective study included 156 patients (mean age 66±8 years, male-to-female ratio 130/26) who underwent simultaneous CEE and CABG between January 2010 and December 2022. Long-term survival was assessed in August 2023. Information was collected by telephone survey, and complete data were obtained for 117 (76%) patients. Median follow-up was 57 (35; 81) months. Mortality, cardiac (angina recurrence, myocardial infarction, percutaneous coronary intervention) and cerebral events (TIA/stroke) were endpoints. Results. Long-term all-cause mortality was 16%, rate of cardiac events in long-term period — 22%. Only 1 (0.9%) ischemic stroke was diagnosed throughout the entire follow-up period. Actuarial overall survival after 3, 5 and 10 years was 93%, 86% and 65%, respectively, freedom from cardiac events — 89%, 77% and 52%, respectively. Chronic kidney disease with GFR<60 mL/min (OR 3.00; 95% CI 1.18—7.66; p=0.021) and lower extremity peripheral artery disease (OR 2.77; 95% CI 1.17—6.55; p=0.020) were significantly associated with cardiac events (recurrence of angina, myocardial infarction) in long-term period. Conclusion. Long-term all-cause mortality in patients undergoing simultaneous CEE and CABG surgery was 16%. The incidence of long-term cerebral events was very low. Chronic kidney disease with GFR<60 ml/min and lower extremity peripheral artery disease were significantly associated with long-term cardiac events.