Stenting Shows Higher In-Hospital Mortality Than CAE

BY MARK S. LESNEY

In a retrospective analysis of discharge data, endovascular treatment of carotid artery stenosis was independently predictive of increased hospital mortality, compared with carotid endarterectomy, reported Dr. Mohammad H. Eslami.

The National Inpatient Sample was queried to identify all patient discharges that occurred for revascularization of carotid artery stenosis by Dr. Eslami, Dr. James T. McPhee, and colleagues at the University of Massachusetts, Worcester. ICD-9-CM diagnostic codes for carotid artery stenosis were used, with and without a diagnosis of stroke (433.11 and 433.10, respectively). These were assessed by the researchers in conjunction with the procedure codes for carotid endarterectomy (CEA, 38.12) and carotid artery stenting (CAS, 39.50, 39.90, and 0.63). The researchers presented their data at the Vascular Annual Meeting

Over the period 2003-2004, there were more than 217,000 carotid artery revascularization discharges recorded, the majority of which (97%) occurred in patients without a diagnosis of stroke. The primary outcome measure was in-hospital mortality. Univariate analysis was done on relevant variables, and multivariable logistic regression was done to evaluate the mortality, with adjustments made for age, sex, medical comorbidities, admission diagnosis, procedure type, year, and hospital type, Dr. Eslami said in an interview.

Results showed that CAS was significantly and independently predictive of in-hospital mortality, compared with CEA, in this patient cohort (odds ratio 2.66, with a 95% confidence interval of 1.6-4.34). Mortality overall (CAS 1.1%; CEA 0.37%) and with stroke (CAS 9.5%; CEA 2.0%) were both significantly different at the P less than .001 level. As might be expected, a diagnosis of stroke, the presence of congestive heart failure, and renal failure were also found to significantly affect in-hospital mortality. The mortality difference between stenting and open surgery without stroke was not significant (CAS 0.54, CEA 0.33). Neither gender nor hospital type (teaching or nonteaching) affected mortality rates. The mean age was similar and mean length of hospital stay was the same in both sets of patients.

The authors concluded that, since U.S. Food and Drug Administration approval based on clinical trials, carotid stenting in clinical practice has significantly increased in-hospital mortality, compared with CEA.