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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2014 Jul 30


lingua: Inglese

Development of a individualized scoring system to predict mid-term survival after carotid endarterectomy

Morales-­Gisbert S. M., Zaragozá García J. M., Plaza Martínez A., Gómez Palonés F. J., Ortiz-­Monzón E.

Department of Angiology, Vascular and Endovascular Surgery, Hospital Universitario Doctor Peset, Valencia, Spain


BACKGROUND AND OBJECTIVES: Carotid endarterectomy (CEA) is a prophylactic surgery focused in preventing stroke in the mid-­long term. The purpose of this study is to analyze mid-­term mortality in patients undergoing CEA, identify predictors of 3-­years mortality and design a score to estimate individual risk of mortality in this population.
METHODS: A retrospective single-­center study including consecutive patients undergoing CEA between 1997-­2010. Demographic data and comorbidities, postoperative results and patient follow-­up data were registered and evaluated. Kaplan Meier analysis was used to analyze survival. After multivariable COX regression analysis, a score based on the calculated Hazards Ratios (HR) was designed. The sum of all points performed the individual score for each patient for estimating 3-­years mortality. Population was stratified into four groups according to percentiles of score obtained: Group A (-­7 to 4 points), Group B (5-­8 points), Group C (9-­10 points), Group D (score greater than 11 points).
RESULTS: A total of 453 patients with a mean follow-­up of 53.4 months were included in the study. Overall 3-­years survival was 88.4%. On the univariate analysis the variables associated with significant increasing in 3-­year mortality were: female gender (OR 2.32), diabetes mellitus (OR 2.28), COPD (OR 2.98), ischemic heart disease (OR 2.29), critical carotid stenosis > 90% (OR 2.16) and anti platelet therapy as a protective factor (OR 0,23). Factors associated with mortality in multivariate analysis were age (HR 1.14 p 0.001), diabetes mellitus (HR 1.62, p 0.031), COPD (HR 1.88 p 0.022), ischemic heart disease (HR 1.59 p 0.05), critical stenosis> 90% (HR 1.70 p 0.015) and antiplatelet therapy as a protective factor (HR 0.23 p 0, 027).The scoring system includes the following items: female gender (+2 points), age (50-­69 years +7 points, 70-­79 years +12 points,> 80 years +15 points), diabetes (+4 points), COPD (+5 points), ischemic heart disease (+4 points), carotid stenosis> 90% (+4 points). Antiplatelet (-­7 points). The score range from -­7 to 26 points. The 3-­years mortality range was 5.6% (Group A) versus 25.5% (Group D).The incidence of stroke at 3-­years folllow-­up was not correlated with the score (99%, 100%, 97% and 94.5%, respectively groups A-­D, p 0.11).
CONCLUSIONS: The score developed based on the risk factors of mortality allows individualized risk prediction of 3-­year mortality in patients with carotid stenosis. This represents a useful and practical tool for decision-­making in the indication of the CEA, allowing surgeons to identify high-­risk patients who would benefit from medical treatment due to their limited life expectancy, mainly in asymptomatic patients.

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