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Higher risk factor burden and worse outcomes in urban carotid endarterectomy patients

Seemant Chaturvedi1, Ramesh Madhavan, Sunitha Santhakumar

  • 1Stroke Program and the Department of Neurology, Wayne State University, Detroit, MI 48201, USA. SChaturv@med.wayne.edu

Stroke
|August 9, 2008
PubMed

Insights

Carotid endarterectomy (CEA) outcomes in urban hospitals were worse than in prior trials due to sicker patients. These findings highlight the need to carefully weigh the risks and benefits of CEA in diverse urban populations.

Area of Science:

  • Vascular Surgery
  • Clinical Outcomes Research
  • Health Disparities

Background:

  • Previous carotid endarterectomy (CEA) trials utilized strict inclusion criteria, limiting representation of diverse patient populations.
  • Urban hospital cohorts often exhibit a higher prevalence of comorbidities and underrepresented racial groups compared to historical trial participants.

Purpose of the Study:

  • To evaluate if CEA outcomes in two urban hospitals align with findings from previous multicenter trials.
  • To assess the impact of patient comorbidities and demographics on CEA efficacy in an urban setting.

Main Methods:

  • Retrospective chart review of CEA procedures conducted in 2003-2004 at two urban hospitals.
  • Analysis of demographic data, medical history, and perioperative complications (stroke, myocardial infarction [MI]).
  • Comparison of observed complication rates against expected rates derived from prior multicenter trial data.

Main Results:

  • The study cohort presented with significantly higher rates of hypertension, diabetes, smoking, Black race, and advanced age compared to previous trials.
  • Observed stroke rates (4.7%) were not significantly different from expected (3.1%), but myocardial infarction (MI) and composite stroke or MI rates were significantly higher.
  • Black patients experienced a higher stroke or MI rate (15.4%) compared to other groups, particularly at the hospital with lower CEA volume.

Conclusions:

  • Carotid endarterectomy (CEA) outcomes in these urban hospitals were poorer than anticipated based on prior multicenter trials.
  • Higher rates of comorbidities and demographic differences in the urban cohort likely contributed to the observed disparities in outcomes.
  • Careful consideration of the risk-benefit ratio is crucial for CEA in urban patients due to their complex medical profiles and associated worse outcomes.
Abstract

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