Abstract
Carotid intima-media thickness (IMT) is a well-known predictor of adverse outcomes in the ischemic heart disease patients; however, evidence is lacking in patients undergoing off-pump coronary artery bypass surgery (OPCAB). Data from 407 patients who underwent OPCAB between April 2013 and August 2016 were retrospectively reviewed. A composite of cardiovascular morbidity endpoints was defined as the presence of stroke, acute myocardial infarction, new cardiac arrhythmia (newly developed atrial fibrillation, atrial flutter, or atrioventricular block), cardiovascular death, or cerebrovascular death within 30 days after surgery. Increased carotid IMT was defined as ≥0.9 mm on one or both sides. The incidence of a composite of cardiovascular morbidity endpoints was 24.0% in the normal IMT group (n = 221) and 34.4% in the increased IMT group (n = 186) (p = 0.021). Multivariable analysis revealed increased IMT (odds ratio 1.719, 95% confidence interval 1.108 to 2.666, p = 0.016) and preoperative renal replacement therapy (odds ratio 4.264, 95% confidence interval 1.679 to 10.829, p = 0.002) as independent predictors of a composite of cardiovascular morbidity endpoints. In patients undergoing OPCAB, preoperative assessment of carotid IMT may help predicting the development of a postoperative composite of cardiovascular morbidity endpoints.
Highlights
The development of intimal thickening has been demonstrated to create a substrate for atherosclerotic stimuli, predisposing the artery to the development of advanced atherosclerosis[1,2]
It imposes the additional burden of surgery on coronary artery disease and percutaneous coronary intervention (PCI), yet avoids risks related to cardiopulmonary bypass (CPB)
In this retrospective study addressing the impact of preoperative carotid intima-media thickness (IMT) on postoperative outcome in Off-pump coronary artery bypass graft (CABG) (OPCAB), we observed a significantly more frequent occurrence of a 30-day composite of cardiovascular morbidity endpoints in the increased IMT (≥0.9 mm) group than in the normal IMT group
Summary
The development of intimal thickening has been demonstrated to create a substrate for atherosclerotic stimuli, predisposing the artery to the development of advanced atherosclerosis[1,2]. Its predictive role extends to patients with ischemic heart disease undergoing percutaneous coronary intervention (PCI), who have advanced atherosclerosis that has progressed far beyond the preclinical stage[7]. Patients undergoing coronary artery bypass graft (CABG) surgery are at a high risk of developing adverse cardiovascular outcomes. Off-pump CABG (OPCAB) serves as an important technique for surgical revascularization, which may be preferred in patients with cerebrovascular risk factors[14] and in elderly patients[15]. It imposes the additional burden of surgery on coronary artery disease and PCI, yet avoids risks related to cardiopulmonary bypass (CPB).
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