Long-term outcomes of simultaneous carotid endarterectomy and coronary artery bypass grafting depending on lower extremity atherosclerosis

Objective. To analyze the long-term outcomes (3-7-10 years) of simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG), mortality, incidence of cardiac and cerebral events depending on severe atherosclerotic lesions of lower limb arteries. Material and methods. The study included 156 patients (mean age 66.0±7.8 years, male/female ratio 130/26) who underwent simultaneous CEA and CABG between January 2010 and December 2022. Long-term survival was assessed in August 2023. Information was collected via telephone survey with complete data obtained for 117 (76%) patients. Patients were divided into 2 groups: group 1 — with significant lesions of lower extremity arteries (n=48), group 2 — without these lesions (n=69). The median follow-up was 57 (35;81) months. The endpoints were all-cause mortality, cardiac (recurrent angina/myocardial infarction) and cerebral (transient ischemic attack/stroke) ischemic events. Results. Both groups were comparable in baseline clinical and demographic characteristics. However, bilateral carotid lesions were more common in the 1st group (73% vs. 54%, p=0.035). There were no in-hospital differences in surgical characteristics, mortality or rate of “major” complications. However, early postoperative encephalopathy was more common in the 1st group (18% vs. 2%, p=0.008). Kaplan-Meier long-term postoperative overall survival did not differ between groups after 3 years (91% and 94%, respectively) and differed quantitatively after 7 and 10 years (70% vs. 86% and 54% vs. 72%, respectively) without statistical significance (p=0.257). Freedom from cardiac events was 82% and 94% after 3 years, 44% and 84% after 7 years, 35% and 67% after 10 years, respectively (p=0.014). Cox regression showed that atherosclerotic lesion of lower limb arteries is a significant and independent predictor of cardiac events (recurrent angina/MI) in long-term postoperative period (HR 2.67; 95% CI 1.18—6.00; p=0.017). One case of ischemic stroke was recorded in the 1st group, and no cerebral events were noted in the 2nd group. Conclusion. Atherosclerotic lesion of lower limb arteries significantly increases the risk of recurrent cardiac ischemic events in long-term period after simultaneous CEA and CABG. This fact should be taken into account when planning postoperative follow-up and secondary prevention strategies.