Abstract 11215: One-Year Clinical Outcomes after Carotid Artery Stenting in Elderly Patients
Background: Carotid artery stenting (CAS) has grown rapidly as an alternative to carotid endarterectomy (CEA) to prevent stroke. Studies have reported that elderly (≥ 80 years, O) patients may have increased risk of periprocedural stroke or death associated with CAS. The aim of this analysis is to identify risk predictors for one-year outcomes after CAS in the elderly using the Medicare database.
Methods: A total of 1323 CAS patients ≥ 66 years meeting inclusion criteria were identified in a 5% nationwide random sample of Medicare beneficiaries from 2004 to 2006. Outcomes included in-hospital and one-year stroke and death rates. Multivariable Cox proportional hazard models were used to adjust for potential confounding variables.
Results: O patients comprised 35 % of CAS and did not differ from a younger cohort (age < 80 yrs, Y) for symptomatic status (related to carotid disease), race and comorbidities except that O had a lower prevalence of chronic obstructive pulmonary disease, obesity, and peripheral vascular disease and a higher prevalence of heart failure, renal failure and female gender. There were no significant differences for in-hospital stroke (1.73%, O vs 1.98%, Y; p=0.75) and all-cause mortality (0.43%, O vs 1.16%, Y; p=0.23) between the 2 groups. By 1year, O had a slightly higher non-significant incidence of stroke (6.2%, O vs 4.9%, Y; p=0.45), death (12.3%, O vs 8.7%, Y; p=0.11) and MI (6.7%, O vs 3.9%, Y; p=0.10). By multivariate analyses, significant predictors in the entire cohort for one-year death/stroke/MI were symptomatic status (HR 2.51, p<0.0001), age ≥ 80 (HR 1.69, p=0.007), and renal failure (HR 1.86, p=0.027). In O only, significant predictor for stroke/ death/MI was limited to symptomatic disease (HR= 2.38, 95%CI 1.20–64.72, p=0.013).
Conclusions: Patients ≥ 80 years have increased risk of one-year adverse outcomes after CAS compared with patients 66–79 years old. Symptomatic status is an independent predictor for increased risk of events in elderly patients.
- © 2010 by American Heart Association, Inc.