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Safety of Carotid Revascularization in Patients With a History of Coronary Heart Disease
BACKGROUND AND PURPOSE—: We investigated whether procedural stroke or death risk of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA) is different in patients with and without history of coronary heart disease (CHD) and whether the treatment-specific impact of age differs. MET...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358179/ https://www.ncbi.nlm.nih.gov/pubmed/30621529 http://dx.doi.org/10.1161/STROKEAHA.118.023085 |
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author | Volkers, Eline J. Algra, Ale Kappelle, L. Jaap Becquemin, Jean-Pierre de Borst, Gert J. Brown, Martin M. Bulbulia, Richard Calvet, David Eckstein, Hans-Henning Fraedrich, Gustav Gregson, John Halliday, Alison Hendrikse, Jeroen Howard, George Jansen, Olav Roubin, Gary S. Bonati, Leo H. Brott, Thomas G. Mas, Jean-Louis Ringleb, Peter A. Greving, Jacoba P. |
author_facet | Volkers, Eline J. Algra, Ale Kappelle, L. Jaap Becquemin, Jean-Pierre de Borst, Gert J. Brown, Martin M. Bulbulia, Richard Calvet, David Eckstein, Hans-Henning Fraedrich, Gustav Gregson, John Halliday, Alison Hendrikse, Jeroen Howard, George Jansen, Olav Roubin, Gary S. Bonati, Leo H. Brott, Thomas G. Mas, Jean-Louis Ringleb, Peter A. Greving, Jacoba P. |
author_sort | Volkers, Eline J. |
collection | PubMed |
description | BACKGROUND AND PURPOSE—: We investigated whether procedural stroke or death risk of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA) is different in patients with and without history of coronary heart disease (CHD) and whether the treatment-specific impact of age differs. METHODS—: We combined individual patient data of 4754 patients with symptomatic carotid stenosis from 4 randomized trials (EVA-3S [Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis], SPACE [Stent-Protected Angioplasty Versus Carotid Endarterectomy], ICSS [International Carotid Stenting Study], and CREST [Carotid Revascularization Endarterectomy Versus Stenting Trial]). Procedural risk was defined as any stroke or death ≤30 days after treatment. We compared procedural risk between both treatments with Cox regression analysis, stratified by history of CHD and age (<70, 70–74, ≥75 years). History of CHD included myocardial infarction, angina, or coronary revascularization. RESULTS—: One thousand two hundred ninety-three (28%) patients had history of CHD. Procedural stroke or death risk was higher in patients with history of CHD. Procedural risk in patients treated with CAS compared with CEA was consistent in patients with history of CHD (8.3% versus 4.6%; hazard ratio [HR], 1.96; 95% CI, 0.67–5.73) and in those without (6.9% versus 3.6%; HR, 1.93; 95% CI, 1.40–2.65; P(interaction)=0.89). In patients with history of CHD, procedural risk was significantly higher after CAS compared with CEA in patients aged ≥75 (CAS-to-CEA HR, 2.78; 95% CI, 1.32–5.85), but not in patients aged <70 (HR, 1.71; 95% CI, 0.79–3.71) and 70 to 74 years (HR, 1.09; 95% CI, 0.45–2.65). In contrast, in patients without history of CHD, procedural risk after CAS was higher in patients aged 70 to 74 (HR, 3.62; 95% CI, 1.80–7.29) and ≥75 years (HR, 2.64; 95% CI, 1.52–4.59), but equal in patients aged <70 years (HR, 1.05; 95% CI, 0.63–1.73; 3-way P(interaction)=0.09). CONCLUSIONS—: History of CHD does not modify procedural stroke or death risk of CAS compared with CEA. CAS might be as safe as CEA in patients with history of CHD aged <75 years, whereas for patients without history of CHD, risk after CAS compared with CEA was only equal in those aged <70 years. |
format | Online Article Text |
id | pubmed-6358179 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-63581792019-02-20 Safety of Carotid Revascularization in Patients With a History of Coronary Heart Disease Volkers, Eline J. Algra, Ale Kappelle, L. Jaap Becquemin, Jean-Pierre de Borst, Gert J. Brown, Martin M. Bulbulia, Richard Calvet, David Eckstein, Hans-Henning Fraedrich, Gustav Gregson, John Halliday, Alison Hendrikse, Jeroen Howard, George Jansen, Olav Roubin, Gary S. Bonati, Leo H. Brott, Thomas G. Mas, Jean-Louis Ringleb, Peter A. Greving, Jacoba P. Stroke Original Contributions BACKGROUND AND PURPOSE—: We investigated whether procedural stroke or death risk of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA) is different in patients with and without history of coronary heart disease (CHD) and whether the treatment-specific impact of age differs. METHODS—: We combined individual patient data of 4754 patients with symptomatic carotid stenosis from 4 randomized trials (EVA-3S [Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis], SPACE [Stent-Protected Angioplasty Versus Carotid Endarterectomy], ICSS [International Carotid Stenting Study], and CREST [Carotid Revascularization Endarterectomy Versus Stenting Trial]). Procedural risk was defined as any stroke or death ≤30 days after treatment. We compared procedural risk between both treatments with Cox regression analysis, stratified by history of CHD and age (<70, 70–74, ≥75 years). History of CHD included myocardial infarction, angina, or coronary revascularization. RESULTS—: One thousand two hundred ninety-three (28%) patients had history of CHD. Procedural stroke or death risk was higher in patients with history of CHD. Procedural risk in patients treated with CAS compared with CEA was consistent in patients with history of CHD (8.3% versus 4.6%; hazard ratio [HR], 1.96; 95% CI, 0.67–5.73) and in those without (6.9% versus 3.6%; HR, 1.93; 95% CI, 1.40–2.65; P(interaction)=0.89). In patients with history of CHD, procedural risk was significantly higher after CAS compared with CEA in patients aged ≥75 (CAS-to-CEA HR, 2.78; 95% CI, 1.32–5.85), but not in patients aged <70 (HR, 1.71; 95% CI, 0.79–3.71) and 70 to 74 years (HR, 1.09; 95% CI, 0.45–2.65). In contrast, in patients without history of CHD, procedural risk after CAS was higher in patients aged 70 to 74 (HR, 3.62; 95% CI, 1.80–7.29) and ≥75 years (HR, 2.64; 95% CI, 1.52–4.59), but equal in patients aged <70 years (HR, 1.05; 95% CI, 0.63–1.73; 3-way P(interaction)=0.09). CONCLUSIONS—: History of CHD does not modify procedural stroke or death risk of CAS compared with CEA. CAS might be as safe as CEA in patients with history of CHD aged <75 years, whereas for patients without history of CHD, risk after CAS compared with CEA was only equal in those aged <70 years. Lippincott Williams & Wilkins 2019-02 2019-01-09 /pmc/articles/PMC6358179/ /pubmed/30621529 http://dx.doi.org/10.1161/STROKEAHA.118.023085 Text en © 2019 The Authors. Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made. |
spellingShingle | Original Contributions Volkers, Eline J. Algra, Ale Kappelle, L. Jaap Becquemin, Jean-Pierre de Borst, Gert J. Brown, Martin M. Bulbulia, Richard Calvet, David Eckstein, Hans-Henning Fraedrich, Gustav Gregson, John Halliday, Alison Hendrikse, Jeroen Howard, George Jansen, Olav Roubin, Gary S. Bonati, Leo H. Brott, Thomas G. Mas, Jean-Louis Ringleb, Peter A. Greving, Jacoba P. Safety of Carotid Revascularization in Patients With a History of Coronary Heart Disease |
title | Safety of Carotid Revascularization in Patients With a History of Coronary Heart Disease |
title_full | Safety of Carotid Revascularization in Patients With a History of Coronary Heart Disease |
title_fullStr | Safety of Carotid Revascularization in Patients With a History of Coronary Heart Disease |
title_full_unstemmed | Safety of Carotid Revascularization in Patients With a History of Coronary Heart Disease |
title_short | Safety of Carotid Revascularization in Patients With a History of Coronary Heart Disease |
title_sort | safety of carotid revascularization in patients with a history of coronary heart disease |
topic | Original Contributions |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358179/ https://www.ncbi.nlm.nih.gov/pubmed/30621529 http://dx.doi.org/10.1161/STROKEAHA.118.023085 |
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