Abstract 11335: A Pre-procedural Risk Model and Risk Score for Adverse Events after Carotid Artery Stenting in High-Surgical Risk Patients from the Stenting and Angioplasty with Protection in Patients at High-Risk for Endarterctomy Worldwide Study
Introduction: Individualized patient selection for carotid artery stenting (CAS) and carotid endarterectomy (CEA) is important in achieving optimal outcomes in patients with carotid atherosclerosis. There are no CAS prediction models for patients specifically at high-risk for CEA. The aim of this study was to generate a risk model and risk score for CAS in patients at high-risk for CEA.
Methods: We studied 10,186 consecutive patients in the Stenting and Angioplasty with Protection in Patients at High-Risk for Endarterectomy (SAPPHIRE) Worldwide Study who underwent CAS with distal protection from 2006 to 2010. Only patients at elevated risk for CEA were eligible in this prospective study. Endpoint events were adjudicated by an independent clinical events committee. Pre-procedural factors were used to develop a model and an integer-based scoring system predicting stroke or death within 30 days. We performed backward selection with univariate prescreening (p<0.2 to enter, multivariate p<0.05 to stay) to generate the logistic model. The model was calibrated and internally validated using bootstrap re-sampling.
Results: The overall rate of stroke or death was 3.6% at 30 days after CAS. Independent predictors of stroke or death at 30 days include age, history of stroke, history of TIA, recent MI, dialysis, the need for cardiac surgery in addition to CAS, a right-sided lesion, lesion length, a type II or III aortic arch, and tortuous carotid vasculature (Table A). The model was well-calibrated (Hosmer-Lemeshow p=0.6). The raw C-statistic was 0.71 and the optimism-adjusted C-statistic was 0.69. An integer-based scoring system is presented in Table A with risk group cutoffs in Table B.
Conclusions: A predictive model using commonly collected, pre-procedural clinical and anatomic variables can identify patients at high and low risk for stroke or death after CAS in a high-surgical risk population.
- © 2012 by American Heart Association, Inc.