The SAPPHIRE criteria, history of myocardial infarction and diabetes predict adverse outcomes following carotid endarterectomy similar to stenting
Tóm tắt
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. 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 < 4 weeks before CEA showed a strong trend (p = 0.05). Patients identified by SHR and SE criteria, prior MI and diabetes warrant increased attention to prevent MACCE following CEA.
Tài liệu tham khảo
MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group (2004) Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 363:1491–1502
Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sackett DL, Thorpe KE, Meldrum HE, Spence JD (1998) Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med 339:1415–1425
ECST collaborators (1998) Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 351:1379–1387
Abbott AL (2009) Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis. Stroke 40:e573–e583
Aboyans V, Ricco JB, Bartelink MEL, Bjorck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debusa S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylora AR, Roffi M, Rotherb J, Sprynger M, Tendera M, Tepe G, Venermoa M, Vlachopoulos C, Desormais I (2018) 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases. Eur Heart J 39:763–821
Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ, Jacobs AK, Smith SC Jr, Anderson JL, Adams CD, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ohman EM, Page RL, Riegel B, Stevenson WG, Tarkington LG, Yancy CW (2011) 2011 ASA/ ACCF/ AHA/ AANN/ AANS/ ACR/ ASNR/ CNS/ SAIP/ SCAI/ SIR/ SNIS/ SVM/ SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. J Am Coll Cardiol 57:e16–94
Kammler J, Blessberger H, Lambert T, Kellermair J, Grund M, Nahler A, Lichtenauer M, Schwarz S, Reiter C, Steinwender C, Kypta A (2017) In-stent restenosis after interventional treatment of carotid artery stenoses: a long-term follow-up of a single center cohort. Clin Res Cardiol 106(7):493–500
Haeusler KG, Gröschel K, Köhrmann M, Anker SD, Brachmann J, Böhm M, Diener HC, Doehner W, Endres M, Gerloff C, Huttner HB, Kaps M, Kirchhof P, Nabavi DG, Nolte CH, Pfeilschifter W, Pieske B, Poli S, Schäbitz WR, Thomalla G, Veltkamp R, Steiner T, Laufs U, Röther J, Wachter R, Schnabel R (2018) Expert opinion paper on atrial fibrillation detection after ischemic stroke. Clin Res Cardiol 107(10):871–880
Rothwell PM, Slattery J, Warlow CP (1997) Clinical and angiographic predictors of stroke and death from carotid endarterectomy: systematic review. BMJ 315:1571–1577
Hannan EL, Popp AJ, Feustel P, Halm E, Bernardini G, Waldman J, Shah D, Chassin MR (2001) Association of surgical specialty and processes of care with patient outcomes for carotid endarterectomy. Stroke 32:2890–2897
Kragsterman B, Logason K, Ahari A, Troëng T, Parsson H, Bergqvist D (2004) Risk factors for complications after carotid endarterectomy—a population-based study. Eur J Vasc Endovasc Surg 28:98–103
Goodney PP, Likosky DS, Cronenwett JL (2008) Factors associated with stroke or death after carotid endarterectomy in Northern New England. J Vasc Surg 48:1139–1145
Halm EA, Tuhrim S, Wang JJ, Rockman C, Riles TS, Chassin MR (2009) Risk factors for perioperative death and stroke after carotid endarterectomy: results of the New York carotid artery surgery study. Stroke 40:221–229
Halm EA, Hannan EL, Rojas M, Tuhrim S, Riles TS, Rockman CB, Chassin MR (2005) Clinical and operative predictors of outcomes of carotid endarterectomy. J Vasc Surg 42:420–428
Gupta PK, Pipinos II, Miller WJ, Gupta H, Shetty S, Johanning JM, Longo GM, Lynch TG (2011) A population-based study of risk factors for stroke after carotid endarterectomy using the ACS NSQIP database. J Surg Res 167:182–191
Bennett KM, Scarborough JE, Shortell CK (2015) Predictors of 30-day postoperative stroke or death after carotid endarterectomy using the 2012 carotid endarterectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg 61:103–111
Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients SAPPHIRE. N Engl J Med 351:1493–1501
Brott TG, Hobson RW, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23
ICSS collaborators (2010) Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study (ICSS)). Lancet 375:985–997
Landesberg G, Shatz V, Akopnik I, Wolf YG, Mayer M, Berlatzky Y, Weissman C, Mosseri M (2003) Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol 42:1547–1554
Macharzina RR, Claus C, Messé SR, Boehme T, Vach W, Winker T, Rastan A, Beschorner U, Noory E, Neumann FJ, Zeller T (2015) History of transient ischaemic attack, myocardial infarction and hyperlipidaemia affects outcome following carotid artery stenting. Eurointervention 11:808–815
Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T (2006) Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke 37:577–617
Mozes G, Sullivan TM, Torres-Russotto DR, Bower TC, Hoskin TL, Sampaio SM, Gloviczki P, Panneton JM, Noel AA, Cherry KJ (2004) Carotid endarterectomy in SAPPHIRE-eligible high-risk patients: implications for selecting patients for carotid angioplasty and stenting. J Vasc Surg 39:958–965
Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ (2004) Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 363:915–924
Sharma M, Hart RG, Connolly SJ, Bosch J, Shestakovska O, Ng KKH, Catanese L, Keltai K, Aboyans V, Alings M, Ha JW, Varigos J, Tonkin A, O'Donnell M, Bhatt DL, Fox K, Maggioni A, Berkowitz SD, Bruns NC, Yusuf S, Eikelboom JW (2019) Stroke outcomes in the COMPASS trial. Circulation 139:1134–1145
Biller J, Feinberg WM, Castaldo JE (1998) Guidelines for carotid endarterectomy. A statement for healthcare professionals from a special writing group of the stroke council. American Heart Association Circulation 97:501–509
Blackshear JL, Cutlip DE, Roubin GS, Hill MD, Leimgruber PP, Begg RJ, Cohen DJ, Eidt JF, Narins CR, Prineas RJ, Glasser SP, Voeks JH, Brott TG (2011) Myocardial infarction after carotid stenting and endarterectomy: results from the carotid revascularization endarterectomy versus stenting trial. Circulation 123:2571–2578
Nicolaides AN, Shifrin EG, Bradbury A, Dhanjil S, Griffin M, Belcaro G, Williams M (1996) Angiographic and duplex grading of internal carotid stenosis: can we overcome the confusion? J Endovasc Surg 3:158–165
Stoner MC, Abbott WM, Wong DR, Hua HT, Lamuraglia GM, Kwolek CJ, Watkins MT, Agnihotri AK, Henderson WG, Khuri S, Cambria RP (2006) Defining the high-risk patient for carotid endarterectomy: an analysis of the prospective National Surgical Quality Improvement Program database. J Vasc Surg 43:285–295
Goldstein LB, McCrory DC, Landsman PB, Samsa GP, Ancukiewicz M, Oddone EZ, Matchar DB (1994) Multicenter review of preoperative risk factors for carotid endarterectomy in patients with ipsilateral symptoms. Stroke 25:1116–1121
Goldstein LB, Samsa GP, Matchar DB, Oddone EZ (1998) Multicenter review of preoperative risk factors for endarterectomy for asymptomatic carotid artery stenosis. Stroke 29:750–753
van Lammeren GW, Catanzariti LM, Peelen LM, de Vries JP, de Kleijn DP, Moll FL, Pasterkamp G, Bots ML (2012) Clinical prediction rule to estimate the absolute 3-year risk of major cardiovascular events after carotid endarterectomy. Stroke 43:1273–1278
Volkers EJ, Algra A, Kappelle LJ, Becquemin JP, de Borst GJ, Brown MM, Bulbulia R, Calvet D, Eckstein HH, Fraedrich G, Gregson J, Halliday A, Hendrikse J, Howard G, Jansen O, Roubin GS, Bonati LH, Brott TG, Mas JL, Ringleb PA, Greving JP (2019) Safety of carotid revascularization in patients with a history of coronary heart disease. Stroke 50:413–418
Illuminati G, Ricco JB, Caliò FG, D’Urso A, Ceccanei G, Vietri F (2008) Results in a consecutive series of 83 surgical corrections of symptomatic stenotic kinking of the internal carotid artery. Surgery 143:134–139