Poor long-term outcomes after carotid endarterectomy: a retrospective analysis of two portuguese centers

• Type: Article in International Scientific Journal
• Date: 2019

Authors

Alves Ferreira, J (Author) Other; Rocha Neves, J (Author) FMUP; Dias-Neto M (Author) FMUP; Braga, SF (Author) Other

Journal

Title: Scandinavian Cardiovascular Journal

Vol. 53

Pages: 266-273

ISSN: 1401-7431

Publisher: Taylor & Francis

Indexing

ISI Web of Knowledge - 13 Citations

Scopus - 13 Citations

Other information

Authenticus ID: P-00Q-TBZ

DOI: 10.1080/14017431.2019.1638518

Abstract (EN): Objetives. Carotid endarterectomy (CEA) is an established treatment for carotid stenosis (CS). However, this procedure is not risk-free and it is insufficient to control disseminated atherosclerosis. Our aim was to determine long-term cardiovascular morbidity and mortality after CEA and identify associated risk predictors. Design. Consecutive cohorts of CEAs performed between 2010 and 2018 in two Portuguese hospitals were retrospectively analysed. The major end-points were acute myocardial infarction (AMI), stroke, all-cause death and major adverse cardiovascular events (MACE). Results. 248 patients (mean age 69 years; 79% male) were enrolled in the study. 24% had postoperative complications. At 52 months median follow-up, 9 +/- 2.0% (mean +/- standard error) of patients experienced an acute myocardial infarction (AMI), 12 +/- 2.4% a stroke and 26 +/- 3.2% a MACE. All-cause mortality rate was 21 +/- 3.0%. Multivariate analysis identified coronary artery disease (CAD) as significant predictor of AMI (p < .001; Hazard Ratio (HR):9.628; 95% Confidence Interval (95%CI):2.805-33.046), whereas no statistically significant risk factor of stroke was found. Predictors of death included left sided CS (p = .042; HR:1.886; 95%CI:1.024-3.475), chronic kidney disease (CKD) (p = .007; HR:2.352; 95%CI:1.266-4.372) and anticoagulant medication (p = .015; HR:2.107; 95%CI:1.216-6.026), while statin use was significantly protective (p = .049; HR:0.482; 95%CI:0.233-0.998). Concerning MACE, male gender (p = .040; HR:1.709; 95%CI:1.025-2.849), tobacco use (p = .004; HR:2.181; 95%CI:1.277-3.726), CAD (p = .002; HR:2.235; 95%CI:1.340-3.727) and CKD (p < .001; HR:3.029; 95%CI:1.745-5.258) were risk predictors. Conclusions. Patients continue to have high rates of AMI, MACE and death after CEA. Prior CAD is a risk factor for future AMI, whereas CKD is a significant predictor of MACE and death. Aggressive best medical treatment and risk factors modification should be advised in all patients with systemic atherosclerosis.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 8