The SAPPHIRE criteria, history of myocardial infarction and diabetes predict adverse outcomes following carotid endarterectomy similar to stenting

Autor: Roland Macharzina, Matthias Siepe, Thomas Winker, Martin Czerny, Thomas Zeller, Steven R. Messé, Michael Weinbeck, Werner Vach, Franz-Josef Neumann, Carolin Müller, Matthias Vogt
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
Adverse outcomes
medicine.medical_treatment
SAPPHIRE trial
Myocardial Infarction
Carotid endarterectomy
Endarterectomy
030204 cardiovascular system & hematology
Lower risk
Asymptomatic
Cohort Studies
Diabetes Complications
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Risk Factors
Diabetes mellitus
Internal medicine
medicine
Odds Ratio
Intraluminal thrombus
Humans
Carotid Stenosis
Carotid artery stenosis
030212 general & internal medicine
Myocardial infarction
Registries
Aged
Aged
80 and over
Endarterectomy
Carotid
Original Paper
business.industry
Hazard ratio
Diabetes
General Medicine
Middle Aged
medicine.disease
Stroke
Logistic Models
Treatment Outcome
Cardiology
Female
Stents
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Zdroj: Clinical Research in Cardiology
ISSN: 1861-0692
Popis: Aims Identifying factors associated with worse outcome following carotid endarterectomy (CEA) is important to improve prevention of major adverse cardiovascular and cerebrovascular events (MACCE), yet rarely used for registries. We intended to identify predictors of MACCE following CEA as recently analysed for stenting. Methods and results Patients undergoing CEA at 2 centers over 13 years were entered into a database. Baseline clinical characteristics, procedural factors and a panel of clinical and lesion-related high-risk features (SHR) and exclusion criteria (SE), empirically compiled for stratification in the SAPPHIRE trial, were differentially analysed using Cox regressions. The analysis included 748 operations; 262 (35%) asymptomatic, 208 (28%) with previous strokes, and 278 (37%) with transient ischemic attacks (TIA). The overall 30-day MACCE rate was 6.7%, 5.0% in asymptomatic and 7.6% in symptomatic patients. Previous MI (HR 2.045, p = 0.022), diabetes (HR 2.111, p = 0.011) and symptomatic patients (HR 2.045, p = 0.044) were independently associated with MACCE. SE patients (n = 81) had a MACCE rate of 13.6%; the MACCE rate of the remainder dropped to 5.8% (4.7% in asymptomatic and 6.5% in symptomatic patients). Hazard ratio for SHR patients was 2.069 (CI 1.087–3.941) and 2.389 for SE (CI 1.223–4.666), each compared to all patients with lower risk and adjusted for symptomatic status. Among SHR and SE criteria NYHA 3–4, contralateral occlusions and intraluminal thrombus were significant determinants and MI p = 0.05). Conclusion Patients identified by SHR and SE criteria, prior MI and diabetes warrant increased attention to prevent MACCE following CEA. Graphic abstract
Databáze: OpenAIRE
Externí odkaz: