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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Prophylactic carotid artery stenting in cardiac surgery candidates – is it worth the risk?
Session:
Posters 4 - Écran 8 - Cardiologia de Intervenção
Speaker:
Luís Puga
Congress:
CPC 2019
Topic:
G. Aortic Disease, Peripheral Vascular Disease, Stroke
Theme:
23. Peripheral Vascular and Cerebrovascular Disease
Subtheme:
23.4 Peripheral Vascular and Cerebrovascular Disease - Treatment
Session Type:
Posters
FP Number:
---
Authors:
Luís Puga; Rogerio Teixeira; Joana Delgado Silva; Diana Decampos; José Luís Costa Martins; Joana M. Ribeiro; Luis Paiva; José Pedro Sousa; João Gameiro; Carolina Saleiro; Marco Costa; Lino Gonçalves
Abstract
<p><strong>Background</strong>: Evidence supporting the benefits of prophylactic revascularization of asymptomatic carotid stenosis in cardiac surgery candidates to reduce perioperative stroke is lacking.</p> <p><strong>Purpose</strong>: To evaluate cardiovascular outcomes in patients undergoing hybrid carotid artery stenting (CAS) and cardiac surgery.</p> <p><strong>Methods</strong>: Single-centre retrospective cohort consisting of 161 patients referred for CAS from February 2001 to December 2017 prior to cardiac surgery either hybrid on the same day or staged. The endpoints evaluated were stroke, myocardial infarction (MI), death and major adverse cardiovascular events (MACE) at 30 days and at 1 year follow up. The sample was further divided in group HYB (hybrid CAS and heart surgery on the same day) and STG (staged CAS prior to heart surgery) to compare both strategies. Event-free survival (MACE) was compared between group HYB and STG by the Kaplan-meier method.</p> <p><strong>Results</strong>: The sample included of 80% (129) males, mean age of 74±8 years old. 66,5% (107) performed CABG while 33,5% (54) performed valvular heart surgery. Group HYB (n=41) and STG (n=111) showed similar cardiovascular risk profile. No statistically significant differences were found between groups in stroke (HYB 0/40 (0%) vs STG 4/110 (3,6%), p=0,222), MI (HYB 0/40 (0%) vs STG 1/109 (0,9%), p=0,543), death (HYB 0/40 (7,5%) vs STG 7/110 (6,4%), p=0,805), MACE (HYB 3/40 (7,5%) vs STG 10/110 (9,1%), p=0,759) at 30 days. The results were also similar at 1 year, stroke (HYB 0/39 (0%) vs STG 5/109 (4,6%), p=0,174), MI (HYB 0/39 (0%) vs STG 5/109 (4,6%), p=0,174), death (HYB 4/39 (10,3%) vs STG 9/109 (8,3%), p=0,705), MACE (HYB 4/39 (10,3%) vs STG 14/109 (12,8)%, p=0,671). Age was the only predictor of MACE at 1 year (odds ratio 1,087 (95% CI 1,005 – 1,175, p=0.038). ROC curve analysis identified 77 years old as a cut off for MACE at 1 year (AUC 0,660 , P=0,02, sensitivity 56% - 95% CI 31-79, specificity 76% 95% CI 68-83). Both groups showed similar event-free survival curves by the Kaplan meier method at one year (HYB 331±16 vs STG 330±10 days, log rank p=0,871) – fig 1. </p> <p><strong>Conclusions</strong>: The frequency of adverse events following CAS in cardiac surgery candidates is considered low in our series. The hybrid strategy on the same day showed similar results in major cardiovascular risk events and adds the advantage of decreasing the waiting time for surgery and risks associated with the double antiplatelet therapy prior to cardiac surgery. The cut point of 77 years old shows that this strategy may be a good option even for old patients.</p>
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