Traditional Risk Factors Provide Limited Insight Into Long-Term Cardiovascular Risk After Carotid Endarterectomy
Ludovica Di Venanzio1, Alessia Pinna1, Negin Mahmoudi Hamidabad1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Major adverse cardiovascular events (MACE) are common after carotid endarterectomy (CEA), with age and prior cardiac events as key predictors. Novel risk assessment is needed for better secondary prevention in carotid artery disease patients.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Surgery
Background:
- Carotid artery disease poses significant cardiovascular and cerebrovascular risks.
- Carotid endarterectomy (CEA) is a common procedure to mitigate these risks.
- Understanding long-term outcomes post-CEA is crucial for patient management.
Purpose of the Study:
- To determine the incidence of major adverse cardiovascular events (MACE) following CEA.
- To identify long-term clinical predictors of MACE in patients with carotid artery disease.
- To assess long-term survival rates compared to the general population.
Main Methods:
- Prospective enrollment of patients from the Mayo Clinic Carotid Artery Atherosclerosis Trial (MCAT) cohort who underwent CEA.
- Definition of MACE including cardiac events, cerebrovascular accidents (CVA), and all-cause mortality.
- Multivariable and covariate analyses to identify clinical predictors of MACE and its components.
Main Results:
- MACE occurred in 62.3% of 710 patients over a median follow-up of 7.1 years.
- Age and a history of cardiac events were independently associated with MACE and all-cause mortality.
- Long-term survival in the cohort was significantly lower than in the general population.
Conclusions:
- Traditional clinical risk factors inadequately explain the high MACE incidence post-CEA.
- Novel approaches for patient profiling are necessary for improved risk assessment.
- Targeted secondary prevention strategies may enhance outcomes for patients with carotid artery disease.
Objective:
To determine the incidence of major adverse cardiovascular events (MACE) and identify long-term clinical predictors in patients with carotid artery disease following carotid endarterectomy (CEA).
Methods:
We prospectively enrolled patients from the Mayo Clinic Carotid Artery Atherosclerosis Trial (MCAT) cohort, who underwent CEA between February 13, 2002, and July 17, 2023. MACE was defined as cardiac events, cerebrovascular accidents (CVA), and all-cause mortality after CEA. Two prespecified models for multivariable and covariate analyses were used to identify clinical predictors of MACE and its individual components.
Results:
Among 710 patients (median age 72.0 [66.0-78.0] years; 465 (65.5%) males), MACE occurred in 442 (62.3%) over a median follow-up of 7.1 [2.9-11.9] years post-CEA. In both multivariable models, age (HR 1.02 [95% CI 1.01-1.04], P=.002; HR 1.03 [95% CI 1.02-1.04], P<.001) and history of cardiac events (HR 1.48 [95% CI 1.17-1.87], P=.001; HR 1.56 [95% CI 1.28-1.89], P<.001) were independently associated with MACE and all-cause mortality (age: HR 1.08 [95%CI 1.05 - 1.10]; P<.001; HR 1.07 [95%CI 1.05 - 1.08]; P<.001, respectively; history of cardiac events: HR 1.48 [95%CI 1.13 - 1.94]; P=.005; HR 1.58 [95%CI 1.27 - 1.97]; P<.001, respectively). Long-term survival of our cohort was significantly lower than in the general population (p<0.001).
Conclusions:
Traditional clinical risk factors showed limited ability to explain the high incidence of MACE following CEA in patients with carotid artery disease. Novel approaches to patient profiling may improve risk assessment and guide targeted secondary prevention in this population.
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease IV: Preventive Measures
01:15Ischemic Stroke l: Introduction
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:27Coronary Artery Disease V: Interprofessional Care
01:26Coronary Artery Disease II: Pathophysiology