{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:55:40Z","timestamp":1753890940661,"version":"3.41.2"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T00:00:00Z","timestamp":1731974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The current research aimed to demonstrate the independent association between preoperative severe asymptomatic carotid artery stenosis (ACAS) and severe multi-organ dysfunction after off-pump coronary artery bypass grafting (OPCAB), which may further indicate the relationship between severe ACAS and adverse 30-day postoperative outcomes of patients undergoing OPCAB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single-center, retrospective observational study including patients without a history of stroke or Transient Ischemic Attacks (TIA) (asymptomatic), who underwent for an isolated OPCAB in the center for operative treatment of coronary artery disease of Beijing Anzhen Hospital from January 2020 to December 2021. All enrolled patients underwent carotid artery ultrasound prior to OPCAB. The information was extracted independently by two authors of the study from the medical records. Both univariate and multivariate analyses were conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 562 patients met the inclusion criteria for the current study. 63 (11.2%) suffered from severe ACAS. The Sequential Organ Failure Assessment (SOFA) maximum in the severe ACAS group was significantly higher than that in the non-severe ACAS group (9.76\u2009\u00b1\u20093.03 vs. 7.75\u2009\u00b1\u20092.96, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001), and a higher proportion of patients in the severe ACAS group exhibited severe multi-organ dysfunction (44.4% vs. 14.0%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001). In addition, severe ACAS was related to an increased rate of 30-day postoperative major adverse cardiovascular and cerebral events (MACCEs), including a 30-day postoperative stroke. Severe ACAS was associated with an elevated risk of delirium, and acute kidney injury (AKI). The results of the multivariate analysis demonstrated that severe ACAS may be independently associated with severe multi-organ dysfunction (OR, 7.37, 95% CI 4.80\u201314.30, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001) after OPCAB. Also, severe ACAS may be independently associated with 30-day postoperative stroke (OR, 2.83, 95% CI 1.03\u20137.75, <jats:italic>p<\/jats:italic>\u2009=\u20090,043).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Severe ACAS was independently associated with severe multi-organ dysfunction after OPCAB, which may be associated further with an increased rate of 30-day postoperative mortality and complications. This study highlights: (1) the importance of personalized assessment for potential advantages and disadvantages in prognosis of severe ACAS patients undergoing OPCAB with carotid endarterectomy; (2) the role of multi-organ parameters, especially cardio-cerebral factors, should be emphasized during the process of severe ACAS management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2024.1399727","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T06:17:49Z","timestamp":1731997069000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The correlation between severe asymptomatic carotid artery stenosis and severe multi-organ dysfunction after off-pump coronary artery bypass grafting"],"prefix":"10.3389","volume":"11","author":[{"given":"Tong","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Cao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ran","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiayang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,11,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1212\/01.WNL.0000158477.55659.FE","article-title":"Simultaneous carotid endarterectomy and coronary artery bypass surgery in Canada","volume":"64","author":"Hill","year":"2005","journal-title":"Neurology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.cjca.2022.02.029","article-title":"Canadian cardiovascular society 2022 guidelines for peripheral arterial disease","volume":"38","author":"Primary Panel: Abramson","year":"2022","journal-title":"Can J Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.cjca.2021.11.007","article-title":"Relationship between the degree of carotid stenosis and the risk of stroke in patients undergoing cardiac surgery","volume":"38","author":"Ruka","year":"2022","journal-title":"Can J Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1016\/j.ejvs.2018.07.042","article-title":"Prognostic impact of asymptomatic carotid artery stenosis in patients undergoing coronary artery bypass grafting","volume":"56","author":"Santarpino","year":"2018","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1053\/ejvs.2002.1609","article-title":"Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature","volume":"23","author":"Naylor","year":"2002","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1056\/NEJM199108153250701","article-title":"Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis","volume":"325","author":"Barnett","year":"1991","journal-title":"N Engl J Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1016\/S0140-6736(97)09292-1","article-title":"Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European carotid surgery trial (ECST)","volume":"351","author":"Greenhall","year":"1998","journal-title":"Lancet"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1056\/NEJM199811123392002","article-title":"Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis","volume":"339","author":"Barnett","year":"1998","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1080\/14779072.2019.1642106","article-title":"Management of patients with concomitant coronary and carotid artery disease","volume":"17","author":"Drakopoulou","year":"2019","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"B10","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1093\/eurheartj\/ehx095","article-title":"2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European society for vascular surgery (ESVS)","volume":"39","author":"Aboyans","year":"2018","journal-title":"Eur Heart J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.jtcvs.2011.10.015","article-title":"2011 ACCF\/AHA guideline for coronary artery bypass graft surgery: executive summary","volume":"143","author":"Hillis","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1177\/1358863X11399328","article-title":"2011 ASA\/ACCF\/AHA\/AANN\/AANS\/ACR\/ASNR\/CNS\/SAIP\/ SCAI\/SIR\/SNIS\/SVM\/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary","volume":"16","author":"Brott","year":"2011","journal-title":"Vasc Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s12893-017-0219-9","article-title":"Sequential organ failure assessment score predicts mortality after coronary artery bypass grafting","volume":"17","author":"Chang","year":"2017","journal-title":"BMC Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1754","DOI":"10.1001\/jama.286.14.1754","article-title":"Serial evaluation of the SOFA score to predict outcome in critically ill patients","volume":"286","author":"Ferreira","year":"2001","journal-title":"JAMA"},{"key":"B15","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1007\/s001340050863","article-title":"Application of SOFA score to trauma patients","volume":"25","author":"Antonelli","year":"1999","journal-title":"Intensive Care Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1001\/jama.287.6.713","article-title":"Sequential assessment of multiple organ dysfunction as a predictor of outcome","volume":"287","author":"Pettila","year":"2002","journal-title":"JAMA"},{"key":"B17","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1161\/CIRCULATIONAHA.107.728147","article-title":"Clinical characteristics and in-hospital outcomes of patients with cardiogenic shock undergoing coronary artery bypass surgery","volume":"117","author":"Mehta","year":"2008","journal-title":"Circulation"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.1016\/j.jacc.2021.09.006","article-title":"2021 ACC\/AHA\/SCAI guideline for coronary artery revascularization","volume":"79","author":"Lawton","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2801","DOI":"10.1161\/STROKEAHA.111.618082","article-title":"Patients with severe asymptomatic carotid artery stenosis do not have a higher risk of stroke and mortality after coronary artery bypass surgery","volume":"42","author":"Mahmoudi","year":"2011","journal-title":"Stroke"},{"key":"B20","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1016\/j.ejvs.2011.02.016","article-title":"Stroke after cardiac surgery and its association with asymptomatic carotid disease: an updated systematic review and meta-analysis","volume":"41","author":"Naylor","year":"2011","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.ejvs.2004.07.011","article-title":"The influence of asymptomatic significant carotid disease on mortality and morbidity in patients undergoing coronary artery bypass surgery","volume":"29","author":"Ghosh","year":"2005","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1016\/j.ejvs.2009.08.001","article-title":"Patients undergoing cardiac surgery with asymptomatic unilateral carotid stenoses have a low risk of peri-operative stroke","volume":"38","author":"Baiou","year":"2009","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1001\/archneurol.2009.114","article-title":"Strokes after cardiac surgery and relationship to carotid stenosis","volume":"66","author":"Li","year":"2009","journal-title":"Arch Neurol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"42161","DOI":"10.1007\/s11356-021-13655-6","article-title":"Evaluation of multiple organ dysfunction score (MODS) and the sequential organ failure assessment (SOFA) score as in-hospital outcome predictors among cases of hydrogen cyanamide exposure: a cross-sectional study","volume":"28","author":"Sharif","year":"2021","journal-title":"Environ Sci Pollut Res Int"},{"key":"B25","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/B978-0-12-819814-8.00015-9","article-title":"Handbook of clinical neurology","volume":"177","author":"Moshayedi","year":"2021","journal-title":"Handb Clin Neurol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2021","DOI":"10.1177\/0271678X17724027","article-title":"Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease","volume":"38","author":"Hartkamp","year":"2018","journal-title":"J Cereb Blood Flow Metab"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1056\/NEJM200006083422302","article-title":"The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis","volume":"342","author":"Inzitari","year":"2000","journal-title":"N Engl J Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"93","DOI":"10.3400\/avd.oa.10.01044","article-title":"Improve morbidity and mortality in coronary artery bypass graft surgery for severe atherosclerosis","volume":"4","author":"Kanemitsu","year":"2011","journal-title":"Ann Vasc Dis"},{"key":"B29","doi-asserted-by":"publisher","first-page":"3270","DOI":"10.1161\/STROKEAHA.121.037493","article-title":"Five-year results of coronary artery bypass grafting with or without carotid endarterectomy in patients with asymptomatic carotid artery stenosis: CABACS RCT","volume":"53","author":"Knipp","year":"2022","journal-title":"Stroke"},{"key":"B30","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.jvs.2004.11.035","article-title":"The influence of concurrent carotid endarterectomy on coronary bypass: a case-controlled study","volume":"41","author":"Ricotta","year":"2005","journal-title":"J Vasc Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/j.amjsurg.2008.07.003","article-title":"Does the duration of surgery affect outcomes in patients undergoing coronary artery bypass grafting?","volume":"196","author":"Chu","year":"2008","journal-title":"Am J Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1186\/s12933-017-0556-0","article-title":"Impact of diabetes duration and degree of carotid artery stenosis on major adverse cardiovascular events: a single-center, retrospective, observational cohort study","volume":"16","author":"Noh","year":"2017","journal-title":"Cardiovasc Diabetol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1399727\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T06:17:52Z","timestamp":1731997072000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1399727\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,19]]},"references-count":32,"alternative-id":["10.3389\/fcvm.2024.1399727"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2024.1399727","relation":{},"ISSN":["2297-055X"],"issn-type":[{"type":"electronic","value":"2297-055X"}],"subject":[],"published":{"date-parts":[[2024,11,19]]},"article-number":"1399727"}}