Background Cerebrovascular atherosclerosis is common in patients undergoing coronary revascularization. Although carotid artery disease has been extensively studied, the association between vertebral artery stenosis and long-term outcomes after isolated off-pump coronary artery bypass grafting (OPCABG) remains uncertain. Methods We performed a retrospective cohort study of consecutive patients undergoing isolated OPCABG at a tertiary cardiac center between January 2018 and July 2021. Preoperative bilateral carotid and vertebral artery duplex ultrasonography was reviewed. Severe cerebrovascular stenosis was defined as 70%–99% luminal narrowing or complete occlusion involving at least one extracranial carotid or vertebral artery. The primary outcome was long-term all-cause mortality. Kaplan–Meier analysis and multivariable Cox proportional hazards regression were used to evaluate associations with mortality. In-hospital postoperative cerebral infarction and 30-day all-cause mortality were additionally summarized. Results Among 1,277 patients, 186 (14.6%) had severe cerebrovascular stenosis, including 100 with severe carotid disease and 109 with severe vertebral disease; 23 patients had both. During a median follow-up of 4.79 years, 87 deaths occurred. Severe carotid stenosis was associated with worse unadjusted survival (log-rank P = 0.028) but was not independently associated with mortality after multivariable adjustment (hazard ratio [HR], 1.35; 95% confidence interval [CI], 0.86–2.13; P = 0.196). Severe vertebral stenosis (HR, 1.86; 95% CI, 1.22–2.84; P = 0.004) and any severe cerebrovascular stenosis (HR, 1.69; 95% CI, 1.21–2.37; P = 0.002) were independently associated with mortality. In-hospital postoperative cerebral infarction (5.91% vs. 0.55%; P < 0.001) and 30-day mortality (4.84% vs. 1.65%; P = 0.011) were more frequent among patients with severe cerebrovascular stenosis. Conclusions Severe cerebrovascular stenosis was associated with increased long-term mortality after isolated OPCABG. Severe vertebral artery stenosis showed the strongest association and may represent a marker of more extensive systemic atherosclerotic disease. These findings support consideration of both carotid and vertebral territories during preoperative vascular assessment, while prospective studies are needed to determine clinical utility.

Cerebrovascular stenosis and mortality after isolated off-pump coronary artery bypass grafting

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2026年7月29日

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YuKang Pei,
Chen Bai,
JianGang Wang

摘要

Background

Cerebrovascular atherosclerosis is common in patients undergoing coronary revascularization. Although carotid artery disease has been extensively studied, the association between vertebral artery stenosis and long-term outcomes after isolated off-pump coronary artery bypass grafting (OPCABG) remains uncertain.

Methods

We performed a retrospective cohort study of consecutive patients undergoing isolated OPCABG at a tertiary cardiac center between January 2018 and July 2021. Preoperative bilateral carotid and vertebral artery duplex ultrasonography was reviewed. Severe cerebrovascular stenosis was defined as 70%–99% luminal narrowing or complete occlusion involving at least one extracranial carotid or vertebral artery. The primary outcome was long-term all-cause mortality. Kaplan–Meier analysis and multivariable Cox proportional hazards regression were used to evaluate associations with mortality. In-hospital postoperative cerebral infarction and 30-day all-cause mortality were additionally summarized.

Results

Among 1,277 patients, 186 (14.6%) had severe cerebrovascular stenosis, including 100 with severe carotid disease and 109 with severe vertebral disease; 23 patients had both. During a median follow-up of 4.79 years, 87 deaths occurred. Severe carotid stenosis was associated with worse unadjusted survival (log-rank P = 0.028) but was not independently associated with mortality after multivariable adjustment (hazard ratio [HR], 1.35; 95% confidence interval [CI], 0.86–2.13; P = 0.196). Severe vertebral stenosis (HR, 1.86; 95% CI, 1.22–2.84; P = 0.004) and any severe cerebrovascular stenosis (HR, 1.69; 95% CI, 1.21–2.37; P = 0.002) were independently associated with mortality. In-hospital postoperative cerebral infarction (5.91% vs. 0.55%; P < 0.001) and 30-day mortality (4.84% vs. 1.65%; P = 0.011) were more frequent among patients with severe cerebrovascular stenosis.

Conclusions

Severe cerebrovascular stenosis was associated with increased long-term mortality after isolated OPCABG. Severe vertebral artery stenosis showed the strongest association and may represent a marker of more extensive systemic atherosclerotic disease. These findings support consideration of both carotid and vertebral territories during preoperative vascular assessment, while prospective studies are needed to determine clinical utility.