The SAPPHIRE criteria, history of myocardial infarction and diabetes predict adverse outcomes following carotid endarterectomy similar to stenting View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-09-25

AUTHORS

Roland Richard Macharzina, Carolin Müller, Matthias Vogt, Steven R. Messé, Werner Vach, Thomas Winker, Michael Weinbeck, Matthias Siepe, Martin Czerny, Franz-Josef Neumann, Thomas Zeller

ABSTRACT

AimsIdentifying factors associated with worse outcome following carotid endarterectomy (CEA) is important to improve prevention of major adverse cardiovascular and cerebrovascular events (MACCE), yet rarely used for registries. We intended to identify predictors of MACCE following CEA as recently analysed for stenting.Methods and resultsPatients undergoing CEA at 2 centers over 13 years were entered into a database. Baseline clinical characteristics, procedural factors and a panel of clinical and lesion-related high-risk features (SHR) and exclusion criteria (SE), empirically compiled for stratification in the SAPPHIRE trial, were differentially analysed using Cox regressions. The analysis included 748 operations; 262 (35%) asymptomatic, 208 (28%) with previous strokes, and 278 (37%) with transient ischemic attacks (TIA). The overall 30-day MACCE rate was 6.7%, 5.0% in asymptomatic and 7.6% in symptomatic patients. Previous MI (HR 2.045, p = 0.022), diabetes (HR 2.111, p = 0.011) and symptomatic patients (HR 2.045, p = 0.044) were independently associated with MACCE. SE patients (n = 81) had a MACCE rate of 13.6%; the MACCE rate of the remainder dropped to 5.8% (4.7% in asymptomatic and 6.5% in symptomatic patients). Hazard ratio for SHR patients was 2.069 (CI 1.087–3.941) and 2.389 for SE (CI 1.223–4.666), each compared to all patients with lower risk and adjusted for symptomatic status. Among SHR and SE criteria NYHA 3–4, contralateral occlusions and intraluminal thrombus were significant determinants and MI < 4 weeks before CEA showed a strong trend (p = 0.05).ConclusionPatients identified by SHR and SE criteria, prior MI and diabetes warrant increased attention to prevent MACCE following CEA.Graphic abstract More... »

PAGES

589-598

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00392-019-01546-3

DOI

http://dx.doi.org/10.1007/s00392-019-01546-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1121260598

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/31555985


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79 myocardial infarction
80 occlusion
81 operation
82 outcomes
83 panel
84 patients
85 predictors
86 predictors of MACCE
87 prevention
88 previous MI
89 previous stroke
90 prior MI
91 procedural factors
92 rate
93 ratio
94 registry
95 regression
96 remainder
97 risk
98 significant determinants
99 status
100 stratification
101 stroke
102 strong trend
103 symptomatic patients
104 symptomatic status
105 thrombus
106 transient ischemic attack
107 trends
108 trials
109 warrants
110 weeks
111 worse outcomes
112 years
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