Jessica B. Wallaert1, Jack L. Cronenwett1, Daniel J. Bertges2, Andres Schanzer3, Randall R. De Martino1, Brian W. Nolan1, Jens Eldrup-Jorgensen4, Philip P. Goodney1
1Dartmouth-Hitchcock Medical Center, Lebanon, NH; 2Fletcher Allen Health Care, Burlington, VT; 3UMass Memorial Health Care, Worcester, MA; 4Maine Medical Center, Portland, ME.
OBJECTIVES: While carotid endarterectomy (CEA) is performed to prevent stroke, long-term survival is essential to ensure benefit, especially in asymptomatic patients. We examined patient factors associated with 5-year survival following CEA in patients with asymptomatic internal carotid artery (ICA) stenosis.
METHODS: Prospectively collected data from 4,294 isolated CEAs performed for asymptomatic stenosis across 24 centers in the Vascular Study Group of New England (VSGNE) between 2003-2011 were used for this analysis. Mortality was determined from the Social Security Death Index. Cox proportional hazard models were used to identify risk factors for mortality within the first 5 years after CEA.
RESULTS: Overall 5-year survival was 82%. In multivariate analysis, increasing strata of age, diabetes, smoking history, congestive heart failure (CHF), COPD, poor renal function (eGFR<60 or dialysis dependence), and degree of contralateral ICA stenosis were all associated with worse survival, while statin use predicted improved survival. Patients classified as low (52%), medium (36%) and high risk (12%) based on number of risk factors had 5-year survival rates of 93%, 85% and 57% respectively (p<0.001, Figure).
CONCLUSIONS: 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. 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.
AUTHOR DISCLOSURES: D. J. Bertges, Nothing to disclose; J. L. Cronenwett, Nothing to disclose; R. R. De Martino, Nothing to disclose; J. Eldrup-Jorgensen, Nothing to disclose; P. P. Goodney, Nothing to disclose; B. W. Nolan, Nothing to disclose; A. Schanzer, Nothing to disclose; J. B. Wallaert, Nothing to disclose.
Posted April 2012