Eighty-two Percent Survived Five Years; High Risk Factor Patients May Not Live to See Benefit of CEA
WASHINGTON, D.C. – While carotid endarterectomy (CEA) is performed to prevent stroke, long-term survival is essential to ensure benefit, especially in asymptomatic patients. A new study presented at the 66th Vascular Annual Meeting presented by the Society for Vascular Surgery® today examined patient factors associated with 5-year survival following CEA in patients with asymptomatic internal carotid artery (ICA) stenosis.
Between 2002-2011 Vascular surgeons from the Vascular Study Group of New England (VSGNE) prospectively collected data from 4,294 isolated CEA’s performed for asymptomatic stenosis from the VSGNE’s 24 centers. Mortality was determined from the Social Security Death Index and Cox proportional hazard models were used to identify risk factors for mortality within the first five years after CEA.
Overall 5-year survival was 82 percent. Patients were classified as low (52 percent), medium (36 percent) and high risk (12 percent) based on number of risk factors had 5-year survival rates of 93 percent, 85 percent and 57 percent respectively (p<0.001). In multivariate analysis, increasing strata of age, diabetes, smoking history, congestive heart failure, chronic obstructive pulmonary disease, poor renal function (eGFR<60 or dialysis dependence), and degree of contralateral ICA were all associated with worse survival, however statin use predicted improved survival.
“More than four out of five asymptomatic patients selected for CEA in the VSGNE achieved 5-year survival, demonstrating appropriate patient selection in our region,” added co-author Jessica B. Wallaert, MD, and instructor of surgery from the Dartmouth Hitchcock Medical Center in Lebanon, N.H. “However, there are patients with high risk profiles, based on the above risk factors, who are unlikely to survive long enough to realize a benefit of CEA for asymptomatic stenosis. Predicting survival is important for decision- making in these patients.”
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