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Poorer outcomes more likely for older patients after carotid stenting
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Elderly patients who underwent carotid artery stenting for severe carotid stenosis were twice as likely to experience worse outcomes than younger patients, according to study data.
Researchers evaluated 878 patients with stenosis who underwent 972 percutaneous carotid interventions. Of these patients, 24% were younger than 65 years, 40% were aged 65 to 74 years and 36% were aged 75 years or older.
MACCE, defined as death, any stroke or MI at 30 days plus long-term ipsilateral stroke, served as the primary endpoint. The secondary endpoint was a composite of any periprocedural stroke plus long-term ipsilateral stroke.
The 30-day MACCE rate was 5.1%, according to the data. The MACCE rate was highest among the oldest group, as compared with the middle-aged group (OR = 2.3; 95% CI, 1.2-4.5) and the youngest group (OR = 2.5; 95% CI, 1.1-5.6). The difference was primarily driven by an increased risk for death (OR = 5.1; 95% CI, 1.1-23.7) and major stroke (OR = 6.8; 95% CI, 1.5-30.8).
After a median follow-up of 5.5 years, 7.3% of patients were lost to follow-up. The estimated 10-year mortality was 67.3%, the estimated 10-year risk for the primary endpoint was 6.9% and the estimated 10-year risk for the stroke endpoint was 5.6%, according to the data. When compared with the middle-aged group, the primary endpoint (HR = 2.3; 95% CI, 1.22-4.36) and the stroke endpoint (HR = 2.03; 95% CI, 1.01-4.1) were more frequent in the oldest group.
The researchers noted that there was no significant difference between age groups in the risk for the primary endpoint and the stroke endpoint in asymptomatic patients. In symptomatic patients, however, the primary endpoint occurred more often in the oldest group, as did the stroke endpoint with borderline significance.
There was no difference in ipsilateral stroke between age groups beyond the periprocedural period, according to the data.
“The long-term risk for the primary endpoint and stroke endpoint was highest in the oldest age group. This difference was mainly driven by the increased MACCE during the first 30 days following the CAS procedure,” the researchers wrote. “Also, after adjustment for baseline and procedural factors, age remained to be independently associated with the primary endpoint.” – by Melissa Foster
Disclosures: The authors report no relevant financial disclosures.
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