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 PS54. Risk-scoring System to Predict Three-year Survival in Patients Treated for Asymptomatic Carotid Stenosis

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

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