A validated risk score to predict outcomes after carotid stenting
Matthias Hoke1, Elmir Ljubuncic, Clemens Steinwender
1Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Austria.
Insights
A new risk score accurately predicts long-term mortality after carotid artery stenting, outperforming individual risk factors. This tool aids in assessing patient outcomes and guiding treatment decisions for improved survival.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- Periprocedural outcomes after carotid artery stenting are well-studied.
- Long-term mortality risk factors following carotid artery stenting require comprehensive assessment.
- Need for a validated clinical risk score for long-term mortality post-stenting.
Purpose of the Study:
- To establish and validate a clinical risk score for predicting long-term mortality in patients who have undergone carotid artery stenting.
Main Methods:
- Prospective investigation of two independent cohorts (602 and 552 patients) after successful carotid artery stenting.
- Utilized multivariable Cox regression and bootstrap variable selection to identify robust risk factors.
- Developed and validated a weighted multimarker risk score and a simplified risk score.
Main Results:
- Identified key risk factors: age, heart failure, diabetes mellitus, low lymphocyte count, prolonged prothrombin time, peripheral artery disease, and contralateral carotid occlusion.
- The multimarker risk score demonstrated strong predictive accuracy (AUC 0.79 in derivation, 0.69 in validation).
- A simplified score effectively stratified patients into distinct risk categories for all-cause mortality.
Conclusions:
- A novel multimarker risk score significantly improves the prediction of long-term mortality after carotid artery stenting.
- This score offers superior prognostic value compared to individual risk factors.
- The developed risk score is a valuable tool for clinical decision-making and patient management.
Background:
Periprocedural outcome has been extensively investigated in patients undergoing carotid artery stenting. However, risk factors contributing to long-term mortality have not been comprehensively assessed. We aimed to establish a validated clinical risk score for long-term mortality in patients after carotid artery stenting.
Methods And Results:
Two independent cohorts after successful carotid artery stenting (602 and 552 patients) were prospectively investigated. Multivariable Cox regression and bootstrap variable selection were used to select the best-fitting multivariable model. The mortality rate was 35% in the derivation and 39% in the validation cohort during a median follow-up of 6.5 and 7.4 years, respectively. The following variables were identified as most robust risk factors in the derivation cohort: age, heart failure, diabetes mellitus, relative lymphocyte count, prothrombin time, peripheral artery disease, and contralateral carotid occlusion. A weighted multimarker risk score yielded an area under the receiver operating characteristic curve of 0.79 in the derivation (P<0.001) and of 0.69 (P<0.001) in the validation cohort. In comparison, the best area under the receiver operating characteristic curves for single risk factors were 0.67 and 0.63, respectively. For optimal clinical use, a simplified risk score was also developed, which discriminated very well from very low to very high risk. The risk of all-cause mortality ranged from 8% for a score of 1 to 93% for a score of 7 (P<0.001) in the derivation and from 11% to 100% in the validation cohort (P<0.001).
Conclusions:
A multimarker risk score outperformed the prognostic value of single risk factors for the prediction of long-term mortality.
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