Comparative effectiveness of carotid arterial stenting versus endarterectomy.
Comparative effectiveness of carotid arterial stenting versus endarterectomy.
复制标题
颈动脉支架置入术与动脉内膜切除术的效果比较。
DOI：
10.1016/j.jvs.2009.05.054
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发表时间：
2009
影响因子：
4.3
通讯作者：
Yang,Feifei
中科院分区：
文献类型：
--
作者：
Groeneveld,PeterW;Yang,Lin;Greenhut,Alexis;Yang,Feifei
背景颈动脉支架(CAS)系统是颈动脉内膜切除术治疗中重度颈动脉狭窄的替代品，但CAS与动脉内膜切除术在预防中风和死亡方面的有效性尚不确定。这项研究的目的是比较接受颈动脉血管重建术的医疗保险受益人在CAS普及之前和之后的临床结果。目的：他的观察性、回溯性队列研究比较了2005年8月至2006年3月(覆盖时代)的46,784名接受颈动脉血管重建的患者与2002年10月至2004年9月(覆盖前时代)之间接受颈动脉血管重建术的倾向分数匹配的患者。方法比较两个时代之间血管重建后90天和270天的死亡率，以及围术期急性心肌梗死和血管重建后90天和270天内任何中风或死亡的综合结果。结果在90天死亡率(2.2%对2.2%；P=.79)、90天综合结果(4.5%对4.3%；P=.13)或270天死亡率(4.8%对4.6%；；P=.17)，但覆盖期间270天的综合结果(7.7%比7.3%；P=.03)。在采用颈动脉支架较高的地区，在覆盖时期，90天死亡率(调整后的优势比[OR]1.15；P=.16)、90天综合结果(OR=1.17；P=.03)、270天死亡率(OR=1.13；P=0.07)和270天综合结果(OR=1.10；P=.09)较高。在颈动脉支架置入率较低的地区，不同时代的事件发生率没有差异。结论颈动脉支架置入治疗颈动脉狭窄与颈动脉血运重建术后不良临床结局的发生率增加有关。
BACKGROUNDCarotid arterial stent (CAS) systems are an alterative to carotid endarterectomy for the treatment of moderate to severe carotid stenosis, but the effectiveness of CAS compared to endarterectomy in preventing stroke and death is uncertain. This study's objective was to compare the clinical outcomes among Medicare beneficiaries undergoing carotid revascularization before and after CAS became widely available.OBJECTIVESThis observational, retrospective cohort study compared 46,784 patients undergoing carotid revascularization from August 2005-March 2006 (the coverage era) to propensity-score-matched patients undergoing carotid revascularization between October 2002-September 2004 (the pre-coverage era), before widespread Medicare coverage of CAS.METHODSMortality was compared at 90 and 270 days after revascularization, as were the combined outcomes of periprocedural acute myocardial infarction and any stroke or death within 90 and 270 days after revascularization, between the two eras. Comparisons were also made between localities with high (23% of carotid procedures being CAS) and lower (9% of carotid procedures being CAS) adoption rates of carotid stents during the coverage era.RESULTSThere were no significant differences in 90-day mortality (2.2% vs 2.2%; P = .79), 90-day combined outcomes (4.5% vs 4.3%; P = .13), or 270-day mortality (4.8% vs 4.6%; P = .17) between the coverage and pre-coverage eras, but there were more 270-day combined outcomes in the coverage era (7.7% vs 7.3%; P = .03). In localities with higher adoption of carotid stents, there was higher 90-day mortality (adjusted odds ratio [OR] 1.15; P = .16), 90-day combined outcomes (OR = 1.17; P = .03), 270-day mortality (OR = 1.13; P = .07), and 270-day combined outcomes (OR = 1.10; P = .09) in the coverage era. There were no differences in event rates between eras in areas with lower carotid stent adoption.CONCLUSIONThe adoption of carotid stents for treatment of carotid stenosis was associated with increased rates of adverse clinical outcomes after carotid revascularization.