Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

5-year results of coronary artery bypass graft surgery with or without carotid endarterectomy in patients with asymptomatic high-grade carotid stenosis: the CABACS randomized controlled trial
S. Knipp1, H. T. Holst2, K. Bilbilis3, H. C. Diener3, H. Jakob1, A. Ruhparwar1, K.-H. Jöckel3, C. Weimar4
1Klinik für Thorax- und Kardiovaskuläre Chirurgie, Universitätsklinikum Essen, Essen; 2Klinik für Herzchirurgie, Universitätsklinik Düsseldorf, Düsseldorf; 3Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinik Essen, Essen; 4BDH Klinik Elzach GmbH, Elzach;

Background and Purpose:

In patients with carotid stenosis, combined coronary and carotid surgery has been widely used despite lack of evidence from randomized trials. Moreover, there are no data on long-term outcome following carotid revascularization versus best medical treatment.

Methods:

In the Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis (CABACS) trial, patients with coronary disease and high-grade carotid stenosis were randomized to receive combined simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) or CABG alone. Primary endpoint was the composite rate of non-fatal stroke or death within 30 days after surgery, with both treatments assumed to be equally safe and efficacious. Secondary endpoints included any stroke, stroke or vascular death and death of any cause, and follow-up was five years. While our previous report focused on primary outcome, here we evaluate the long-term results of the trial.

Results:

The trial was terminated prematurely after recruitment of 129 patients in 17 centers in Germany and the Czech Republic. The rate of stroke or death at 30 days was not significantly different following combined CABG+CEA and CABG alone (18.5% (95% confidence interval [95% CI]: 0.099-0.300) versus 9.7% (95% CI: 0.036-0.199), p=0.203). By 5 years, stroke or death rate was 40.6% (95% CI: 0.285-0.536) following CABG+CEA and 35.0% (95% CI: 0.231-0.484) following CABG alone (p=0.581). Strokes of any kind tended to occur more frequently after CABG+CEA (5 years: 29.4% vs. 18.8%, p=0.245), while death rate was similar in both treatment arms (25.4% vs 23.3% (p=0.837). Subgroup analysis revealed no significant effect of center on outcomes.

Conclusions:

Combined simultaneous CABG+CEA revealed almost double perioperative risk of stroke or death compared with CABG alone, and this effect was not counterbalanced during 5-year follow-up. Therefore, combined simultaneous coronary and carotid revascularization should not be recommended in patients with asymptomatic carotid stenosis.

Registration:

http://www.controlled-trials.com; ISRCTN13486906.


https://dgk.org/kongress_programme/jt2022/aP2037.html