The Impact of Biochemical Markers on Major Adverse Cardiovascular Events and Contralateral Carotid Artery Stenosis Progression Following Carotid Interventions.

Autor:	Stone PA; Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV. Electronic address: pstone0627@yahoo.com., Thompson SN; Charleston Area Medical Center Health Education and Research Institute, Charleston, WV., Khan M; Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV., Northfield E; Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV., Schillinger R; Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV., Skaff P; Charleston Area Medical Center Health Education and Research Institute, Charleston, WV.
Jazyk:	angličtina
Zdroj:	Annals of vascular surgery [Ann Vasc Surg] 2017 Jan; Vol. 38, pp. 144-150. Date of Electronic Publication: 2016 Aug 19.
DOI:	10.1016/j.avsg.2016.08.004
Abstrakt:	Backgroud: To determine if elevated preintervention high-sensitivity C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP) levels associate with major adverse cardiovascular events (MACE) or disease progression after carotid revascularization. Methods: We retrospectively examined patients receiving elective carotid endarterectomy (CEA) or carotid artery stenting (CAS) at our institution from 2007 to 2014. All included patients had preintervention hsCRP and BNP levels. Examined outcomes of interest included contralateral carotid disease progression (increased stenosis or need for revascularization) and MACE (composite of death, stroke, myocardial infarction, need for coronary artery bypass graft or percutaneous coronary intervention) at 3 years after procedure. The relationship between baseline hsCRP and BNP levels and time to event was examined by univariate and multivariate Cox proportional hazard regression analyses. Results: A total of 248 patients were included in the analysis (mean age: 68 ± 10 years), with 14% receiving CAS and 86% CEA. A total of 61 patients (25%) had 1 or more MACE by 3 years. Elevated hsCRP (>3 mg/L) trended toward associating with MACE but failed to reach significance (hazard ratio [HR]: 1.6 [1.0-2.7], P = 0.07). Multivariate analysis found that elevated BNP (>100pg/mL, HR: 2.2 [1.3-3.7], P = 0.002) and diabetes mellitus (HR: 1.9 [1.2-3.2], P = 0.01) predicted MACE. Having elevated preprocedural levels of both hsCRP and BNP significantly increased patients' likelihood of experiencing MACE (HR: 3.4 [1.6-7.1], P = 0.001). About 175 patients received contralateral carotid imaging postprocedure and of those patients, 31 (18%) experienced stenosis progression and/or revascularization within 3 years. However, neither elevated hsCRP (HR: 1.2 [0.6-2.3], P = 0.68) nor BNP (HR: 1.1 [0.5-2.5], P = 0.88) associated with disease progression. Conclusions: BNP elevation at the time of carotid intervention is associated with MACE in long-term follow-up. hsCRP does not appear to correlate with either disease progression of the contralateral artery or MACE. (Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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