Cardiol Rev. 2025 Nov 20. doi: 10.1097/CRD.0000000000001134. Online ahead of print.
ABSTRACT
The management of patients with concomitant coronary artery disease and carotid artery stenosis undergoing coronary artery bypass grafting (CABG) remains controversial. While synchronous carotid endarterectomy (CEA) with CABG may reduce perioperative stroke, its long-term benefit compared with staged procedures is unclear. This study systematically reviewed and meta-analyzed long-term outcomes of synchronous versus staged CEA with CABG. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was searched up to July 2025. Eligible studies included randomized controlled trials and cohort studies reporting long-term outcomes after synchronous or staged CEA/CABG. Pooled risk ratio (RR) with 95% confidence intervals (CIs) was calculated using a random-effects model. Twenty-five studies, including 35,781 patients, were analyzed, of whom 6828 underwent synchronous and 28,953 staged procedures. Long-term mortality was significantly lower with staged surgery (RR: 1.26, 95% CI: 1.15-1.37, P < 0.00001, I² = 0%). No significant differences were observed between synchronous and staged approaches for stroke (RR: 1.16, 95% CI: 0.75-1.77), myocardial infarction (MI) (RR: 0.83, 95% CI: 0.54-1.28), or major adverse cardiovascular events (MACE) (RR: 0.99, 95% CI: 0.85-1.16). Among patients undergoing synchronous CEA/CABG, pooled long-term incidences were 14.6% for mortality, 6.2% for stroke, 5.0% for MI, and 17.5% for MACE. Long-term stroke, MI, and MACE rates are broadly comparable between synchronous and staged CEA with CABG. However, staged procedures appear to provide a survival advantage, with significantly reduced long-term mortality. Further multicenter randomized trials are warranted to confirm these findings and optimize patient selection.
PMID:41297045 | DOI:10.1097/CRD.0000000000001134