Risk scoring system to predict life expectancy after CEA in patients with asymptomatic carotid artery stenosis
Altro
Data di Pubblicazione:
2014
Citazione:
Risk scoring system to predict life expectancy after CEA in patients with asymptomatic carotid artery stenosis / I. Barbetta, D. Bissacco, M. Carmo, M. Bonzini, V. Catanese, S. Di Gregorio, P. Settembrini. ((Intervento presentato al 28. convegno Annual meeting of the European Society for Vascular Surgery tenutosi a Stockolm nel 2014.
Abstract:
Introduction:
Surgical treatment of asymptomatic carotid stenosis is currently debated. Reduction of
the risk of stroke is partially counterbalanced by perioperative events. Therefore, recent
guidelines recommend exclusion of patients without a minimum life-expectancy of 3-5
years. Purpose of this study is to identify factors associated with a higher mortality
during long-term follow-up after carotid endarterectomy (CEA). Subsequently to design
a scoring system for stratifying the expected survival of candidates to CEA, based on
each patient’s risk factors.
Methods:
From 2002 to 2013, 648 asymptomatic patients underwent CEA. Data on preoperative
comorbidities and postoperative complications were extrapolated and converted to
dichotomous variables. Hazard Ratios (HR) were calculated for each risk factor using
Cox regression models. We assigned to each risk factor a score based on the weight of
their beta coefficients in a uni-variate analysis using the lowest value as reference. For
each patient we calculated total risk score as the sum of all risk factors. Kaplan-Meyer’s
survival curves were designed after grouping patients according to their level of preoperative
risk, based on their individual risk score.
Results:
42 males (66%) and 219 females (34%) with a mean age of 74 years (range 47-93)
were operated in the study period. Combined 30-days postoperative stroke/death rate
was 1.23%. Patients were followed for a median of 56 months (IQR 27-84). 5-years
survival was 84%. The following coefficients were assigned to factors that negatively
influenced life-expectancy after surgical procedure: 8 points to dialysis (HR 7.74)
P=.005 and age ≥80 (HR 7.43; P=.0001) 4 points to Creatinine ≥1.5 mg/dL (HR 3.03;
P=.0001) and age 70-79 (HR 3.22; P=.004) 1 point to COPD (HR 1.42; P=.23) lack of
statins on treatment (HR 1.55; P=.08) any therapy for diabetes mellitus (HR 1.36; P=.17
and CAD (past MI or coronary intervention) (HR 1.30; P=.34) 5-years survival rate was
97% for patients with score 0-3, 89% for score 4-8, 79% for score 9-12, and 66% for
score 12-16 (P<0.0001).
Conclusion:
In our experience with asymptomatic CEA, we report a low rate of perioperative events
and a high proportion of patients surviving more than 5 years after the procedure, in
accordance with current literature. Our scoring system is a simple clinical tool for
prediction of post-operative life expectancy that could be easily implemented to
conventional perioperative risk assessment for selection of asymptomatic patients who
would benefit from CEA.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Keywords:
carotid stenosi ; stroke ; CEA
Elenco autori:
I. Barbetta, D. Bissacco, M. Carmo, M. Bonzini, V. Catanese, S. Di Gregorio, P. Settembrini
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