Long-term results
Telephone or clinical interviews were conducted in April 2021. For staged operations’ groups, the assessment was carried out after both stages of reconstructive interventions were performed. The maximum follow–up time for the patient was 78 months, the minimum was 4 months. Average follow-up time: 41.1±21.8 months. The endpoints were death from all causes, ACVA, TIA, MI, as well as a combined endpoint, including death from all causes, acute MI, ACVA, TIA during the patient’s hospitalization.
We managed to contact 225 patients out of 243 operated (92.6%). We were unable to find out long-term results in 3 patients from the staged interventions’ group (the first stage of CABG), 7 patients from the staged interventions’ group (the first stage of CEA) and 8 patients from the combined interventions’ group. The overall survival rate was 93.8% (92.9% for the stage group (the first stage of CABG), 93.3% for the stage group (the first stage of CEA) and 94.8% for the combined interventions’ group, p=0.807). 14 people died (6,2%) – 7 (7,1%) in the group with the first stage of CABG, 2 (6.7%) in the group with the first stage of CEA and 5 (5.2%) in the combined group. In total, 5 (2.4%) MI cases – 2 (9.1%) were recorded in the group with first performed CABG, 1 (3.3%) in the group with first performed CEA and 2 (2.1%) in the combined group, and 11 (4.9%) ACVA cases – 4 (4.0%) in the group with first performed CABG, 3 (10%) in the group with first performed CEA and 4 (4.1%) in the simultaneous interventions’ group. There was also 1 (1.0%) TIA case in the stage group (the first stage of CABG). One person in the combined group died from MI, there weren’t fatal cases from MI in the staged interventions’ group. 1 person died from ACVA in both stage groups and 1 person in the combined group. The combined point was 15 (15.2%) in the stage group (the first stage of CABG), 5 (16.7%) in the stage group (the first stage of CEA) and 11 (10.6%) in the combined group. There weren’t identified significant differences between groups in the any studied parameters and endpoints (Table. IV).
In the analysis by Kaplan-Meier survival within 6 years in the simultaneous interventions’ group represented 94.8% in the group stage of the interventions (first stage CABG) – 92,9% in the group stage of the interventions (the first stage of the CEA) – 93,3% with corresponding 95% confidence intervals (Figure 2A). In the survival analysis by logrank test isn’t statistically significant differences (χ2=0,487, p=0,784).
The groups didn’t differ in terms of freedom from MI in the long-term postoperative period (Figure 2B). For the combined group, this indicator was 97.9%, for the stage group (the first stage of CABG) – 97.9%, for the group of stage interventions (the first stage of CEA) – 96.7% (χ2=0.013, p=0.994).
When analyzing the freedom from ACVA according to the logrank criterion, there also weren’t differences between the groups (Figure 2C). Thus, the indicator for the combined group was 95.8%, for the stage group (the first stage of CABG) – 95.7%, for the stage group (the first stage of CEA) - 90.0% (χ2=0.410, p=0.815).
When comparing the freedom from the combined endpoint complications (mortality from all causes + MI+ACVA+TIA) by the Kaplan-Mayer method, several events summation in one patient didn’t occur, but it was believed that one complication occurred, due to this method’s peculiarities. Freedom from the combined indicator development (lethality from all causes + MI+ACVA+TIA) for 6 years was 91.7% for the simultaneous interventions’ group, 87.9% for the group in which CABG was performed at the first stage and 86.7% for the group in which the first stage was performed CEA (χ2=0.952, p=0.621) (Figure 2D).