• Vascular Annual Meeting
• 2009 Exhibitor Information
• Future Meeting Dates
• Past Meeting Information
• Contact Us

Home > Vascular Annual Meeting > pvss19_protack_metabolic

PVSS19. Metabolic Syndrome: A Predictor of Adverse Outcomes After Carotid Revascularization?

Clinton D. Protack, Andrew M. Bakken, Eric K. Peden, Alan B. Lumsden, Mark G. Davies.
The Methodist Hospital, Houston, Texas.

OBJECTIVES: Metabolic syndrome (MetS) is rapidly increasing in prevalence and is associated with carotid plaque development and is a risk factor for stroke. The aim of this study is to describe the outcomes for patients with metabolic syndrome after carotid revascularization [carotid endarterectomy (CEA) and carotid stenting (CAS)].

METHODS: A database of patients undergoing carotid revascularization for primary atherosclerotic lesions was queried from 1998 to 2006. MetS was defined as the presence of ≥3 of the following criteria: Blood pressure ≥130 mmHg/≥80 mmHg; Triglycerides ≥150 mg/dl; HDL ≤50 mg/dl for women and ≤40 mg/dl for men; Fasting blood glucose ≥110 mg/dl; or Body Mass Index ≥30 kg/m2. Multivariate and Kaplan-Meier analyses were performed to outcomes. The average follow-up period was 4.5 years.

RESULTS: 843 patients (mean age: 71±10 years; 64% male) underwent 750 CEAs and 171 CAS. 31% were identified as having MetS. 63% were asymptomatic. 87% had hypertension. 27% had hyperlipidemia. 32% were considered diabetic, and 14% had chronic renal insufficiency. The perioperative morbidity and 30-day mortality rates were 16.4% and 1.1%, respectively. MetS patients were more likely to experience a complication than Non-MetS patients (19% vs. 14%, p=0.04). The 30- and 90-day Major Adverse Events (MAE) rates (Death, Stroke, MI) were 4.3% and 5.9%, respectively; however those with MetS experienced a higher 30-day MAE (6.9% vs. 3.5%, p=0.02) and 90-day MAE (8.7% vs. 4.9%, p=0.03). MetS patients were more likely to experience stroke (8.0% vs. 4.3%, p=0.03) and MI (17.4% vs. 5.7%, p<0.001) during follow-up versus Non-MetS patients. By Kaplan-Meier analysis, there was no difference between MetS and Non-MetS patients with respect to patency, restenosis, re-intervention, or survival, but a difference existed for freedom from stroke, MI and MAE. See Table 1 for 3-year outcome rates.

CONCLUSIONS: MetS is prevalent among patients undergoing carotid revascularization. MetS patients are at a greater risk for perioperative morbidity as well as stroke, MI and MAE during follow-up when compared to patients without MetS. Long-term stroke prevention is poor in the presence of MetS. MetS should be considered a significant risk factor for patients undergoing carotid revascularization.