Risk factors for perioperative death and stroke after carotid endarterectomy: results of the new york carotid artery surgery study.
Risk factors for perioperative death and stroke after carotid endarterectomy: results of the new york carotid artery surgery study.
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DOI：
10.1161/strokeaha.108.524785
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发表时间：
2009-01
期刊：
影响因子：
8.3
通讯作者：
Chassin MR
中科院分区：
文献类型：
--
作者：
Halm EA;Tuhrim S;Wang JJ;Rockman C;Riles TS;Chassin MR
颈动脉内膜剥脱术(CEA)的益处受到围手术期死亡或中风风险的严重影响。这项研究开发了一个预测CEA后30天内死亡或中风风险的多变量模型。纽约颈动脉手术(NYCAS)研究是一项基于人群的队列研究，从1998年1月到1999年6月对纽约州的医疗保险患者进行了9308例CEA。从病历中提取详细的临床数据以评估社会人口学、神经学和共病危险因素。医生的过度阅读证实了手术后30天内的死亡和中风。采用多变量Logistic回归分析确定患者的独立危险因素。无卒中/TIA病史的无症状患者30d死亡率为2.71%，有远期卒中/TIA病史的患者为4.06%，颈动脉TIA手术患者为5.62%，卒中患者为7.89%，进展期患者为13.33%。死亡或卒中的显著多变量预测因素包括：年龄≥80岁(OR=1.30；95%CI，1.03-1.64)，非白人(OR=1.83；1.23-2.72)，急诊科入院(OR=1.95；1.50-2.54)，无症状但远期卒中/短暂性脑缺血发作(OR=1.40；1.02-1.94)，短暂性脑缺血发作作为手术指征(OR=1.81；1.39-2.36)，卒中为指征(OR=2.40；对侧颈动脉狭窄≥50%(OR=1.44；1.15~1.79)，重度残疾(OR=2.94；1.91~4.50)，冠心病(OR=1.51；1.20~1.91)，胰岛素依赖型糖尿病(OR=1.55；1.10~2.18)。颈动脉深部溃疡的存在具有临界性意义(OR=2.08；0.93~4.68)。几个社会人口学、神经学和共病危险因素预测CEA术后围手术期死亡或卒中。这些信息可能有助于为适当的患者选择提供信息，并有助于比较提供者之间的风险调整结果或不同手术护理过程的影响。
The benefit of carotid endarterectomy(CEA) is heavily influenced by the risk of perioperative death or stroke. This study developed a multivariable model predicting the risk of death or stroke within 30 days of CEA. The New York Carotid Artery Surgery (NYCAS) Study is a population-based cohort of 9308 CEAs performed on Medicare patients from January 1998 through June 1999 in New York State. Detailed clinical data were abstracted from medical charts to assess sociodemographic, neurological, and comorbidity risk factors. Deaths and strokes within 30 days of surgery were confirmed by physician over-reading. Multivariable logistic regression was used to identify independent patient risk factors. The 30-day rate of death or stroke was 2.71% among asymptomatic patients with no history of stroke/TIA, 4.06% among asymptomatic ones with a distant history of stroke/TIA, 5.62% among those operated on for carotid TIA, 7.89% of those with stroke, and 13.33% in those with crescendo TIA/stroke-in-evolution. Significant multivariable predictors of death or stroke included: age ≥80 years(OR=1.30; 95% CI, 1.03-1.64), non-white(OR=1.83; 1.23-2.72), admission from the ED(OR=1.95; 1.50-2.54), asymptomatic but distant history of stroke/TIA (OR=1.40; 1.02-1.94), TIA as indication for surgery(OR=1.81; 1.39-2.36), stroke as the indication(OR=2.40; 1.74-3.31), crescendo TIA/stroke-in-evolution(OR=3.61; 1.15-11.28), contralateral carotid stenosis ≥50%(OR=1.44; 1.15-1.79), severe disability(OR=2.94; 1.91-4.50), coronary artery disease(OR=1.51; 1.20-1.91), and diabetes on insulin(OR=1.55; 1.10-2.18). Presence of a deep carotid ulcer was of borderline significance (OR=2.08; 0.93-4.68). Several sociodemographic, neurological, and comorbidity risk factors predicted perioperative death or stroke after CEA. This information may help inform decisions about appropriate patient selection and facilitate comparisons of risk-adjusted outcomes among providers or about the impact of different surgical processes of care.