Abstract：
BACKGROUND: There is no complete consensus on the three surgical methods and long-term consequences for coexisting coronary and carotid artery disease. We retrospectively evaluated the surgical results in this high-risk group in our clinic for a decade.
METHODS: Between 2005 and 2015, 196 patients were treated for combined carotid and coronary artery disease. A total of 50 patients were operated on with the staged method, 40 of which had carotid endarterectomy (CEA) priority, and 10 had coronary artery bypass grafting (CABG) priority. CABG and CEA were simultaneously performed in 82 patients; and in 64 asymptomatic patients with unilateral carotid artery lesions and stenosis over 70%, only CABG was done (64 patients). Results were evaluated by uni-/multivariate analyses for perioperative, early, and late postoperative data.
RESULTS: In the staged group, interval between the operations was 2.82±0.74 months. Perioperative and early postoperative (30 days) parameters did not differ between groups (P-value < 0.05). Postoperative follow-up time was averaged 94.9±38.3 months. Postoperative events were examined in three groups as (A) deaths (all cause), (B) cardiovascular events (non-fatal myocardial infarction, recurrent angina, congestive heart failure, palpitation), and (C) fatal neurological events (amaurosis fugax, transient ischemic attack, and stroke). When group C events were excluded, event-free actuarial survival rates were similar in all three methods (P=0.740). Actuarial survival rate was significantly different when all events were included (P=0.027). Neurological events increased markedly between months 34 and 66 (P=0.004).
CONCLUSIONS: Perioperative and early postoperative event-free survival rates were similar in all three methods. By the beginning of the 34th month, the only CABG group has been negatively separated due to neurological events. In the choice of methodology, \"most threatened organ priority\'\' was considered as clinical parameter.
METHODS: Between 2005 and 2015, 196 patients were treated for combined carotid and coronary artery disease. A total of 50 patients were operated on with the staged method, 40 of which had carotid endarterectomy (CEA) priority, and 10 had coronary artery bypass grafting (CABG) priority. CABG and CEA were simultaneously performed in 82 patients; and in 64 asymptomatic patients with unilateral carotid artery lesions and stenosis over 70%, only CABG was done (64 patients). Results were evaluated by uni-/multivariate analyses for perioperative, early, and late postoperative data.
RESULTS: In the staged group, interval between the operations was 2.82±0.74 months. Perioperative and early postoperative (30 days) parameters did not differ between groups (P-value < 0.05). Postoperative follow-up time was averaged 94.9±38.3 months. Postoperative events were examined in three groups as (A) deaths (all cause), (B) cardiovascular events (non-fatal myocardial infarction, recurrent angina, congestive heart failure, palpitation), and (C) fatal neurological events (amaurosis fugax, transient ischemic attack, and stroke). When group C events were excluded, event-free actuarial survival rates were similar in all three methods (P=0.740). Actuarial survival rate was significantly different when all events were included (P=0.027). Neurological events increased markedly between months 34 and 66 (P=0.004).
CONCLUSIONS: Perioperative and early postoperative event-free survival rates were similar in all three methods. By the beginning of the 34th month, the only CABG group has been negatively separated due to neurological events. In the choice of methodology, \"most threatened organ priority\'\' was considered as clinical parameter.
摘要：
背景：关于三种手术方法以及并存的冠状动脉和颈动脉疾病的长期后果，尚无完全共识。我们回顾性评估了十年来在我们的诊所中这个高危人群的手术结果。
方法：在2005年至2015年期间，196例合并颈动脉和冠状动脉疾病的患者接受了治疗。对50例患者进行分期手术,其中40人优先进行颈动脉内膜切除术（CEA），10例优先进行冠状动脉旁路移植术（CABG）。82例患者同时行CABG和CEA；64例无症状患者单侧颈动脉病变和狭窄超过70％，仅进行了CABG(64例患者).结果通过围手术期的单/多变量分析进行评估，早期，和术后后期数据。
结果：在分期组中，手术间隔为2.82±0.74个月。围手术期和术后早期（30天）参数组间无差异（P值<0.05）。术后随访时间平均为94.9±38.3个月。将三组的术后事件检查为（A）死亡（所有原因），（B）心血管事件（非致死性心肌梗死，复发性心绞痛,充血性心力衰竭,心悸)，和（C）致命的神经系统事件（黑蒙，短暂性脑缺血发作,和中风）。当排除C组事件时，三种方法的无事件精算生存率相似(P=0.740).当包括所有事件时，精算生存率显着差异（P=0.027）。神经系统事件在34至66个月之间显着增加（P=0.004）。
结论：三种方法的围手术期和术后早期无事件生存率相似。到第34个月初，唯一的CABG组因神经系统事件而呈阴性分离.在方法论的选择上,“最受威胁的器官优先级”被认为是临床参数。
方法：在2005年至2015年期间，196例合并颈动脉和冠状动脉疾病的患者接受了治疗。对50例患者进行分期手术,其中40人优先进行颈动脉内膜切除术（CEA），10例优先进行冠状动脉旁路移植术（CABG）。82例患者同时行CABG和CEA；64例无症状患者单侧颈动脉病变和狭窄超过70％，仅进行了CABG(64例患者).结果通过围手术期的单/多变量分析进行评估，早期，和术后后期数据。
结果：在分期组中，手术间隔为2.82±0.74个月。围手术期和术后早期（30天）参数组间无差异（P值<0.05）。术后随访时间平均为94.9±38.3个月。将三组的术后事件检查为（A）死亡（所有原因），（B）心血管事件（非致死性心肌梗死，复发性心绞痛,充血性心力衰竭,心悸)，和（C）致命的神经系统事件（黑蒙，短暂性脑缺血发作,和中风）。当排除C组事件时，三种方法的无事件精算生存率相似(P=0.740).当包括所有事件时，精算生存率显着差异（P=0.027）。神经系统事件在34至66个月之间显着增加（P=0.004）。
结论：三种方法的围手术期和术后早期无事件生存率相似。到第34个月初，唯一的CABG组因神经系统事件而呈阴性分离.在方法论的选择上,“最受威胁的器官优先级”被认为是临床参数。
