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Acute Myocardial Infarction in Rats
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Periprocedural Stroke and Myocardial Infarction as Risks for Long-Term Mortality in CREST.

Michael R Jones1, George Howard2, Gary S Roubin3

  • 1Department of Cardiology, Baptist Health Lexington, KY (M.R.J.).

Circulation. Cardiovascular Quality and Outcomes
|December 21, 2018
PubMed
Summary

Periprocedural stroke in the CREST trial significantly increases early mortality risk. Periprocedural myocardial infarction (MI) or biomarker-only events increase both early and late mortality risk over 10 years.

Keywords:
cerebrovascular diseasemortalitymyocardial infarctionstrokesurvival

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Area of Science:

  • Cardiovascular medicine
  • Neurology
  • Clinical trials

Background:

  • The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) previously identified increased mortality up to 4 years post-procedure for patients experiencing periprocedural stroke or cardiac events.
  • This analysis extends the CREST trial's follow-up to 10 years to further evaluate long-term mortality risks associated with these events.

Purpose of the Study:

  • To assess the 10-year mortality risk associated with periprocedural stroke, myocardial infarction (MI), or biomarker-only events following carotid revascularization procedures.
  • To differentiate the temporal patterns of mortality risk (early vs. late) for different types of periprocedural events.

Main Methods:

  • Utilized proportional hazards models to analyze 10-year mortality data from the CREST randomized controlled trial.
  • Compared mortality risk in patients with and without periprocedural stroke, protocol MI, or biomarker-only events.

Main Results:

  • Periprocedural stroke was associated with a 1.74-fold increased risk of death over 10 years, primarily driven by early mortality (0-90 days).
  • Periprocedural MI conferred a 3.61-fold increased risk of death, with significant increases in both early and late mortality.
  • Biomarker-only events showed a 2.04-fold increased overall mortality risk, with significant early risk and a suggestive increase in late risk.

Conclusions:

  • Periprocedural events in the CREST trial are linked to substantial 10-year mortality increases.
  • Stroke-related mortality risk is concentrated in the early post-procedure period.
  • Myocardial infarction and biomarker-only events are associated with sustained increased mortality risk throughout the 10-year follow-up period, highlighting the need for strategies to mitigate these events and manage cardiac complications.