Abstract 14735: Carotid Artery Stenting and Carotid Endarterectomy are Comparable Among Medicare Beneficiaries Treated in Routine Clinical Practice
Introduction: The relative performance of carotid artery stenting (CAS) and carotid endarterectomy (CEA) among Medicare beneficiaries in routine clinical practice has not been established.
Objective: To compare the performance of CAS relative to CEA among Medicare beneficiaries.
Methods: We linked Medicare data (2000-2009) to the Society for Vascular Surgery’s Vascular Registry (SVS-VR; 2005-2008) and to the NCDR® Carotid Artery Revascularization and Endarterectomy Registry (CARE; 2006-2008/9). Medicare patients aged ≥66 years undergoing CAS or CEA were followed from the procedure date for the outcomes of death, stroke/transient ischemic attack (TIA), peri-procedural myocardial infarction (MI) or a composite endpoint for these outcomes. We derived high-dimensional propensity scores using registry and Medicare
data to control for patient-level factors and adjusted for provider-level factors including past-year CAS/CEA physician and hospital volume, hospital ownership, teaching affiliation, and hospital size in a Cox regression model comparing CAS to CEA.
Results: Among 5,254 SVS-VR (1,999 CAS and 3,255 CEA) and 4,055 CARE (2,824 CAS and 1,231 CEA) patients, CAS patients were more often at higher surgical risk (SVS-VR: 96.7% vs. 44.5%; CARE: 71.3% vs. 44.7%) and had a higher comorbidity burden. Crude outcome risks for death and stroke/TIA were lower for CEA. Adjusting for patient-level factors drove estimates downwards for CAS relative to CEA but only after further adjustment for provider-level factors did the performance of CAS and CEA become comparable on all outcomes (figure 1).
Conclusion: Performance of CAS and CEA among Medicare beneficiaries was comparable after accounting for patient- and provider-level factors, which is consistent with landmark trials. Further studies are needed to understand the role of heterogeneity in provider-level characteristics.
Author Disclosures: J.J. Jalbert: None. L.L. Nguyen: None. M.D. Gerhard-Herman: None. L.A. Williams: None. C. Chen: None. J. Liu: None. H. Kumamaru: None. A.T. Rothman: None. M.R. Jaff: Consultant/Advisory Board; Modest; Dr. Jaff is a non-compensated advisor to: Abbott Vascular; Cordis Corporation; Covidien Vascular; Medtronic Vascular. Other; Modest; Dr. Jaff is also a board member at VIVA Physicians, a 501(c) 3 not-for-profit education and research consortium. J.D. Seeger: Consultant/Advisory Board; Modest; Dr. Seeger is a paid consultant to Optum Insight and WHISCON. J.F. Benenati: Consultant/Advisory Board; Modest; Dr. Benenati has served on the advisory board of Abbott, Cordis, Angiodynamics, and Surefire and has served as a consultant for Gore and Cook. P.A. Schneider: Consultant/Advisory Board; Modest; Dr. Schneider has served as a board member of VIVA, 501(c) 3 nonprofit. H.D. Aronow: Other; Modest; Dr. Aronow chairs the SCAI CAS Expert Consensus Document Writing Committee and serves in the Society for Vascular Medicine, the American College of Cardiology (Peripheral Vascular Disease Committee),. J.A. Johnston: Employment; Significant; Dr. Johnston is a full-time employee of Eli Lilly and Company. T.G. Brott: None. T.T. Tsai: None. C.J. White: None. S. Setoguchi: Research Grant; Modest; Dr. Setoguchi is supported by a mid-career development award grant K02-HS017731 from the AHRQ, U.S. DHHS. Consultant/Advisory Board; Modest; She also reported receiving research support from Johnson & Johnson and receiving personal income for consulting from Sanofi-Aventis.
- © 2014 by American Heart Association, Inc.