Abstract 2: Outcomes Of Carotid Endarterctomy In The Elderly: A Report From The Care Registry ®

Abstract

Background: Although stroke affects the elderly disproportionately, benchmark clinical trials of CEA often did not include this population at all or in insufficient numbers. Because trial patients are chosen rather strictly, the results may not be easily generalized and must be applied cautiously to the general population. The CARE Registry is a hospital wide web based data collection tool designed to assess use quality and outcomes of cardiovascular procedures including CEA. We determined the perioperative outcomes of CEA based upon age. Methods: Details of data collection and management in the CARE Registry has been previously published. Using the dataset we analyzed the outcome of CEA procedures done in elderly symptomatic and asymptomatic patients (age > 70 years). We compared outcomes (discharge status, and risk of stroke or death) stratified by age. Statistical analysis was performed by using Student’s t- test for continuous variables and Chi square or Fisher’s exact test for categorical variables Results: There were a total of 4149 symptomatic and asymptomatic patients > 70 who underwent CEA. Mean age was 78.1 + 5.2 years of which 59% were male. 96% were Caucasian, 89.7% had hypertension, 32.4% had diabetes, and 65% were smokers. The overall mortality rate after the procedure was 0.5%. New stroke or TIA was documented in 2.0%. Risk of combined stroke or death was 2.3%. The risk of death was highest in the 85 years and over group compared to the 70-75, 75-80 and the 80-85 years groups (p=0.002). The combined risk of death or stroke was also highest in the >85 years group (4.9%, p=0.001) compared to the other groups. Among symptomatic elderly patients, the risk of death (0.5% vs. 0.4%, p=1.00) and risk of combined perioperative stroke and death 2.8% vs. 3.2%,p=0.67) was not statistically different between those <75 years compared to those >75 years. Among asymptomatic elderly patients who underwent CEA, the risk of death was significantly higher among those >75 years compared to those < 75 years 0.7% vs 0.0% p=0.006) and the combined risk of death or perioperative stroke was 2.2% vs. 1.6%, p=0.25) Conclusions: In the CARE Registry, elderly patients more than 85 years of age are at increased risk of death or perioperative complications of stroke compared to those relatively younger. Elderly patients undergoing CEA for asymptomatic carotid stenosis also had higher mortality than the younger counterparts.