Francisco Alcocer, Marjan Mujib, Jeffrey Horn, Marc A. Passman, Mark A. Patterson, Thomas C. Matthews, William D. Jordan
Surgery, University of Alabama at Birmingham, Birmingham, AL.
OBJECTIVES: To identify risk factors compromising 3-year survival in treated patients with asymptomatic carotid disease in complying with recently updated guidelines from the Society for Vascular Surgery.
METHODS: Outcomes of 504 patients who underwent carotid intervention for asymptomatic carotid disease in 10 years (1999-2008) were analyzed. Hospital computerized medical records were reviewed. Social Security Death Index was queried for mortality. Patients lost to follow up before 3 years post procedure were excluded. After multivariable Cox regression analysis was done, a score was assigned for each risk factor (RF): Hazard Ratio (HR) 1.5-2.0=RF 1; HR 2.1-3.0=RF 2; HR 3.1-4.0=RF 3. Then a Kaplan Meier plot analyzed survival differences.
RESULTS: Fifteen percent of the patients did not survive beyond 3 years post procedure. Age >80 years (HR 2.0, p=0.01, RF=1), Chronic obstructive pulmonary disease (HR 3.6, p=0.001, RF=3), Chronic kidney disease (CKD) stage 3 (HR 2.0 p=0.07, RF=1), CKD stage 4 (HR 3.3, p=0.04, RF=3), Coronary artery disease (HR 2.46, p=0.001, RF=2) and Diabetes Mellitus (HR 1.8, p=0.02, RF=1) negatively influenced 3-year survival. Thirty days’ mortality rate was 0.9% and was not influenced by score values; however, a cumulative score < 3 was associated with 3 year survival of 93%.
CONCLUSIONS: Despite low 30-day mortality rate, increasing risk factors are associated with decreased 3-year survival. This finding may impact clinical decision for management of asymptomatic carotid disease.
AUTHOR DISCLOSURES: F. Alcocer, Nothing to disclose; J. Horn, Nothing to disclose; W. D. Jordan, Nothing to disclose; T. C. Matthews, Nothing to disclose; M. Mujib, Nothing to disclose; M. A. Passman, Nothing to disclose; M. A. Patterson, Nothing to disclose.
Figure: Kaplan-Meier Survival Plots by Risk Score
Posted April 2012