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Six variables predictive of in-hospital stroke, death after carotid stenting
Six clinical variables comprised a risk score that may predict in-hospital stroke or death after carotid artery stenting to aid clinical decision making and improve patient selection, according to registry data.
The study, which was initially presented at the Society for Cardiovascular Angiography and Intervention 2012 Scientific Sessions, included patients undergoing carotid artery stenting (CAS) without acute evolving stroke from April 2005 to June 2011 as part of the National Cardiovascular Data Registry (NCDR) Carotid Artery Revascularization and Endarterectomy (CARE) Registry. Researchers looked at 35 variables in all.
A total of 271 (2.4%) primary endpoint events occurred during 11,122 procedures. Six predictors of stroke or death included:
- Impending major surgery (OR=2.20; 95% CI, 1.34-3.61);
- Previous stroke (OR=2.03; 95% CI, 1.53-2.70);
- Age (per 10 years; OR=1.76; 95% CI, 1.55-2.01);
- Target lesion symptomatic within 6 months (OR=1.55; 95% CI, 1.21-2.00);
- Atrial fibrillation or flutter (OR=1.41; 95% CI, 1.04-1.92);
- Previous ipsilateral carotid endarterectomy (CEA; OR=0.63; 0.42-0.94).
Overall, the model was well calibrated with moderate discriminatory ability (C-statistic=0.71) and within symptomatic (C-statistic=0.68) and asymptomatic (C-statistic=0.72) subgroups. Available angiographic variables did not improve model performance (C-statistic=0.72; integrated discrimination improvement, 0.001; P=.21).
This tool may be useful to assist clinicians in evaluating optimal management, share more accurate pre-procedural risks with patients and improve patient selection for CAS, the researchers wrote.
“In an environment where two carotid revascularization strategies each pose unique risks influenced by patient characteristics, a schema for risk assessment is necessary to assist patients in selecting the most appropriate therapy,” they said. “The NCDR CAS risk score may enable clinicians to identify those patients at excessive risk of CAS so that medical therapy or CEA may be offered as alternatives. Similarly, in patients with prohibitive risk with CEA, this risk score is helpful in identifying patients with acceptable CAS risk.”