Risk Factors for Mortality within 5 Years of Carotid Endarterectomy for Asymptomatic Stenosis. Journal Article

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Authors: Blecha, M; DeJong, M; Carlson, K
Article Title: Risk Factors for Mortality within 5 Years of Carotid Endarterectomy for Asymptomatic Stenosis.
Abstract: OBJECTIVES: Current Society of Vascular Surgery guidelines for the management of patients with asymptomatic carotid stenosis recommend endarterectomy for patients with greater than 70% stenosis and acceptable surgical risk. The reduced rate of stroke with modern medical therapy increases the importance of careful selection in deciding which patients undergo elective CEA for asymptomatic disease. It is therefore very prudent to investigate pre-existing variables predictive of 5 year mortality amongst patients meeting criteria to undergo CEA. METHODS: The Vascular Quality Initiative was queried dating back to 2003 for all CEA. Inclusion in the study required : 1 ) documentation of survival status, 2) complete data on all the incorporated demographic study variables, and 3) asymptomatic neurological status. Variables present at the time of surgery were investigated using Binary logistic regression to identify multivariate predictors of 5 year mortality. The highest risk variables were then interrogated for an additive effect regarding long term mortality. Sub-analysis was performed for patients over 80. RESULTS: 30,615 patients met inclusion criteria of whom 5414 (18%) experienced mortality within 5 years. The highest risk variables were classified as those which had both an adjusted odds ratio of greater than 1.25, P value of .001, and Beta Coefficient of .25 or greater. These included : body mass index under 20; diabetes mellitus; history of congestive heart failure; renal insufficiency; end stage renal disease; chronic obstructive pulmonary disease; living status other than home; prior lower extremity bypass; prior major amputation; Black race relative to other races combined; hemoglobin under 10 mg/dl; history of neck irradiation; and history of smoking. Age had an annual odds ratio of 1.04, P.001. Other variables which achieved statistical significance (P.05) in predicting 5 year mortality were : coronary artery disease, positive stress test or myocardial infarction within two years; lower extremity arterial intervention; aneurysm repair; and, taking P2Y inhibitor at the time of surgery. Taking statin and aspirin medications at the time of surgery were both protective against 5 year mortality (P.001). CONCLUSIONS: We identified 12 particularly high risk variables which in combination progressively predict increasing mortality within 5 years of CEA performed for asymptomatic stenosis. Special attention should be paid to patients over 80 years old, patients with any history of congestive heart failure regardless of current symptoms, COPD, renal insufficiency or ESRD, patients with PAD, Diabetics, and patients with variables associated with frailty (anemia, assisted living status).
Journal Title: Journal of vascular surgery
ISSN: 1097-6809; 0741-5214
Publisher: Mosby, Inc  
Date Published: 2022