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Risk score for peri-interventional complications of carotid artery stenting
Robert Hofmann1, Alexander Niessner, Alexander Kypta
1Cardiovascular Division, City Hospital Linz, Austria, A-4020 Linz, Krankenhausstr. 9. robert.hofmann@akh.linz.at
Insights
A new risk score identifies patients at high risk for complications after carotid artery stenting (CAS). The score uses accessible factors like diabetes and age to predict stroke and death within 30 days.
Area of Science:
- Vascular Surgery
- Cardiology
- Neurology
Background:
- Independent risk factors for peri-interventional outcomes in carotid artery stenting (CAS) are not routinely available.
- A need exists for a reliable risk assessment tool to identify high-risk patients undergoing elective CAS.
Purpose of the Study:
- To develop and validate a risk score for predicting peri-interventional complications in patients undergoing elective CAS.
- To identify key independent risk factors for adverse outcomes within 30 days post-CAS.
Main Methods:
- Prospective enrollment of 606 consecutive patients undergoing elective CAS.
- Collection of biochemical, clinical, and lesion-related risk factors.
- Primary endpoint: periprocedural complications including stroke, myocardial infarction, and all-cause mortality within 30 days.
Main Results:
- Diabetes with poor glycemic control (HbA1c > 7%), age ≥ 80 years, carotid artery stenosis ulceration, and contralateral stenosis ≥ 50% were identified as independent risk factors.
- The developed risk score demonstrated a superior predictive value (C-statistic = 0.73) compared to individual factors.
- Patients with two or more risk factors had an 11% risk of periprocedural complications, versus 2% for those with zero or one factor.
Conclusions:
- A risk score utilizing routinely accessible variables effectively identifies high-risk patients for atherothrombotic events and mortality after elective CAS.
- This tool aids in stratifying patients and potentially optimizing peri-interventional management.
Background And Purpose:
Routinely available independent risk factors for the peri-interventional outcome of patients undergoing elective carotid artery stenting (CAS) are lacking. The rationale of the study was to create a risk score identifying high-risk patients.
Methods:
We prospectively enrolled 606 consecutive patients assigned to CAS at a secondary care hospital. Various biochemical, clinical, and lesion-related risk factors were prospectively defined. The primary end point reflecting periprocedural complications encompassed minor and major stroke, nonfatal myocardial infarction and all-cause mortality within 30 days.
Results:
Three percent of patients (n=18) experienced a nonfatal minor (n=13) or major (n=5) stroke. 1.3% of patients (n=8) died from fatal stroke (n=4) or other causes (n=4). No myocardial infarction was observed within 30 days after stenting. Multivariable analysis revealed diabetes mellitus with inadequate glycemic control (HbA1c > 7%), age > or = 80 years, ulceration of the carotid artery stenosis, and a contralateral stenosis > or = 50% as independent risk factors. A risk score formed with these variables showed a superior predictive value (C-statistic = 0.73) compared with single risk factors. The presence of 2 or more of these risk factors identified patients with a risk of 11% for a periprocedural complication compared with 2% in patients with a score of 0 or 1.
Conclusions:
In patients undergoing elective CAS, a risk score based on routinely accessible variables was able to identify patients at high-risk for atherothrombotic events and all-cause death within 30 days after the intervention.
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