Long-term Survival after Carotid Endarterectomy in a Population with a Low Coronary Heart Disease Fatality:
Carlos Ruiz-Carmona1, Carles Diaz-Duran1, Nerea Sevilla1
1Angiology and Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
Long-term survival after carotid endarterectomy (CEA) in a Mediterranean population was assessed. Cancer was the leading cause of death, and survival rates were at the lower range observed in other studies.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Oncology
Background:
- Long-term survival is crucial for managing severe asymptomatic carotid stenosis.
- Limited data exist for populations with low coronary heart disease incidence.
- This study evaluates long-term survival post-carotid endarterectomy (CEA) in a Mediterranean setting.
Purpose of the Study:
- To assess long-term survival rates following CEA.
- To identify risk factors associated with long-term survival after CEA.
- To understand the influence of regional characteristics on survival outcomes.
Main Methods:
- Retrospective analysis of 291 patients undergoing CEA (2005-2014).
- Kaplan-Meier life table analysis and multivariable Cox regression were employed.
- Risk factors for long-term survival were analyzed.
Main Results:
- Immediate combined mortality/morbidity was 2.7%.
- Mean follow-up was 55 months; 21.3% of patients died, with cancer being the most frequent cause (35.5%).
- Independent survival predictors included age, ASA class IV, and preoperative hemoglobin. 3- and 5-year survival rates were 89% and 81%.
Conclusions:
- Long-term survival in this CEA cohort was at the lower end of reported ranges.
- Cancer significantly impacted long-term survival.
- Predictive survival models may be influenced by regional factors.
Background:
According to the current guidelines, long-term survival is an important factor influencing decision making in patients with severe asymptomatic carotid stenosis. Nevertheless, data are lacking for populations with a low incidence of coronary heart disease, the main cause of death among these patients. We aimed to assess the long-term survival after carotid endarterectomy (CEA) in a Mediterranean hospital.
Methods:
Retrospective analysis was conducted of 291 consecutive patients (main age 69 years, 78.7% men) who underwent a CEA for symptomatic (n = 147, 50.5%) or asymptomatic (n = 144, 49.5%) carotid stenosis in 2005-2014 at the Hospital del Mar (Barcelona, Spain). A Kaplan-Meier life table was done and a multivariable Cox regression model was built for the analysis of the long-term survival-associated risk factors.
Results:
The immediate combined mortality and/or neurological morbidity rate was 2.7%. The mean follow-up was 55 months (complete in 99.7%). During follow-up 62 patients (21.3%) died, being cancer the most frequent cause (35.5%). Cumulative 3- and 5-year survival rates were 89% and 81%, respectively. Independent risk factors (Cox regression) related to survival included age (hazards ratio [HR] 1.09, P < 0.001), an American Society of Anesthesiologists class IV score (HR 4.04, P = 0.015), and the preoperative hemoglobin value (HR 0.73, P < 0.001). The discrimination of the resulting model was 0.719 (95% confidence interval 0.644-0.794). Previous symptomatic carotid stenosis was not related to long-term survival.
Conclusions:
The long-term survival of patients submitted to CEA in our series lies in the lower limit of the estimated range by other groups and is markedly related to cancer. Our study suggests that predictive models for survival are influenced by regional characteristics.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:26Coronary Artery Disease IV: Preventive Measures
01:26Atherosclerosis III: Management