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HF, other factors affect outcomes in CAS before open-heart surgery
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Congestive HF and renal insufficiency were among the factors predicting poor outcomes in patients who received carotid artery stenting followed by open-heart surgery, researchers reported.
CAS followed by open-heart surgery was safe and effective for most of the 323 consecutive patients (mean age, 65 years; 81% men) in the study, according to Hui Dong, MD, from the department of cardiology at Fuwai Hospital and the National Center for Cardiovascular Diseases at the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, and colleagues.
The primary endpoint was a composite of major stroke, MI or death at 1 year after CAS. The researchers also conducted analyses to identify predictors of poor outcomes in the population.
At 1 year after CAS, the primary endpoint occurred in 5.6% of patients. According to a Cox regression analysis performed by the researchers, predictors of the primary endpoint at 1 year were performing open-heart surgery 5 days or fewer after CAS (HR = 4.85; 95% CI, 1.87-12.58), congestive HF (HR = 4.08; 95% CI, 1.45-11.51) and renal insufficiency (HR = 4.56; 95% CI, 1.28-16.32).
Between CAS and 30 days after open-heart surgery, the primary endpoint occurred in 4.6% of patients. Predictors of the primary endpoint during this time window were performing open-heart surgery 5 days or fewer after CAS (HR = 4.51; 95% CI, 1.52-13.36) and congestive HF (HR = 5.32; 95% CI, 1.63-17.43), the researchers wrote.
“CAS followed by [open-heart surgery] may be a safe and effective treatment for patients with concomitant carotid and cardiac disease, given the low periprocedural and 12-month complication rates observed in this study,” Dong and colleagues wrote. “Patients with an interval of 5 days between CAS and [open-heart surgery], congestive heart failure and renal insufficiency have a higher rate of combined major stroke, MI and any death during 1-year follow-up. Further studies including large randomized trials are needed to verify these findings.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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