A Meta-analysis Of Preoperative Carotid Ultrasound In Predicting The Risk Of Stroke After Coronary Artery Bypass Grafting

Objective: Whether Carotid artery stenosis ultrasound can reduce the risk of postoperative stroke in patients undergoing coronary artery bypass grafting is unclear.Preoperative carotid ultrasonography and prophylactic revascularization according to the degree of stenosis is a diagnostic and therapeutic measure,this Meta-analysis focused on the rationality and effectiveness of preoperative ultrasonography for carotid artery and prophylactic revascularization.To search all clinical literature on Carotid artery stenosis and preventive treatment in patients undergoing coronary artery bypass grafting compared with patients undergoing coronary artery bypass grafting alone.By comparing the incidence of adverse events in patients after surgery,to evaluate whether the diagnostic and therapeutic measures can reduce the incidence of postoperative stroke,mortality,myocardial infarction and the composite incidence of local complications.And to determine whether preoperative carotid ultrasonography has the effect of predicting the occurrence of stroke.Methods: The Cochrane Library,Pub-Med,EMSCO,Ovid,China Biological Literature Database(CBM),China Journal Full-Text Database(CNKI),Wanfang and other Chinese and English databases were searched by computer,and the time limit was for the literature published between the establishment of Cochrane Library and October 2022.According to the inclusion and exclusion criteria,all clinical randomized controlled trials on preoperative carotid artery stenosis examination and preventive treatment warning of postoperative stroke occurrence in patients undergoing coronary artery bypass surgery were included,and the included literatures were evaluated methodologically.Rev Man5.4 software was used to analyze the combined effect values of all indexes of cardiovascular and cerebrovascular adverse events by using random effect model or fixed effect model according to the consistency test results.Combined effect values of count data were expressed by Relative Risk(RR)OR Odds Ratio(OR)and 95% Confidence Interval(95%CI).Heterogeneity was tested by I2(Higgins I-square,I2),and heterogeneity was indicated by I2 exceeding 75%.A forest plot was drawn for each combined effect value,and a P value < 0.05 was considered to have a significant difference.Results: A total of 31 randomized controlled trials on reducing the incidence of cardiovascular and cerebrovascular adverse events in patients undergoing coronary artery bypass surgery for preoperative carotid artery stenosis prophylactic revascularization were searched and included,with a total of 19,996 patients.Thirteen of the literatures were based on a statistical analysis of the surgical population with risk factors for stroke.In this paper,a meta-analysis was performed on various postoperative cardiovascular and cerebrovascular adverse event indicators in the literature after screening.The main results showed that the incidence of perioperative stroke(≤30 days)in patients undergoing carotid artery ultrasound after coronary artery bypass surgery was higher than that in the CABG alone group considering high risk factors(OR=0.57;95%CI:0.33,0.98)and postoperative mortality(OR=0.53;95%CI:0.30,0.94).The incidence of long-term stroke(> 90 days)after surgery(OR=0.62;95%CI:0.41,0.93)and perioperative local complication rates were also significantly different(OR=0.66;95%CI:0.46,0.95),but there was no significant difference in the incidence of postoperative myocardial infarction(OR=1.30;95%CI:0.59,2.89).The incidence of perioperative myocardial infarction(OR=1.90;95%CI:0.45,8.03)showed no significant difference,and we also found the incidence of perioperative stroke(OR=1.33;95%CI:1.00,1.77),incidence of postoperative long-term stroke(OR=3.15;95%CI:2.05,4.85)and perioperative death rate(OR=1.19;95%CI:0.86,1.63)and the incidence of postoperative local complications(OR=1.67;95%CI:1.36,2.06)could not be reduced,and all risks were statistically increased.Conclusion: In this Meta-analysis,preoperative ultrasonography and prophylactic treatment(revascularization)can reduce the incidence of perioperative stroke,postoperative mortality,long-term stroke and local complications in patients with coronary artery bypass grafting(CABG).Preoperative ultrasound examination of the carotid artery has the effect of predicting the occurrence of stroke.