Abstract 339: Predictors of Periopertive Neurologic Outcomes Following CEA

Abstract

Objective: The prospective registry study intended to identify risk factors of periinterventional neurologic outcomes after carotid endarteriectomy (CEA) to improve patient selection. Neurologic outcome predicition differs from the endpoint MACCE as previously shown. Methods: Patient characteristics and procedural factors were prospectively acquired and analysed using Cox regression to determine predictors for stroke and death within 30-days of CEA. Results: The analysis included 748 operations, 262 (35%) asymptomatic, 208 (28%) with previous strokes, and 278 (37%) with transient ischemic attacks (TIA). The overall 30-day stroke rate was 5.5%, 3.1% in asymptomatic and 6.8% in symptomatic patients and for stroke and death 5.6%, 3.1% and 7.0% respectively. Independent predictors of stroke and death were contralateral occlusion (HR=3.826, p=0.006, CI 1.483 - 9.867), symptomatic status (HR=3.626, p=0.004, CI 1.51 - 8.706), First-degree atrioventricular block (HR=2.209, p=0.041, CI 1.034 - 4.722), resection (HR=2.448, p=0.027, CI 1.106 - 5.416) and myocardial infarction (HR=2.03, p=0.04, CI 1.032 - 3.994) compared to all patients. Similar effect estimates were found for stroke alone. Compared to lower risk patients, SHR and SEC criteria predicted stroke and death after adjustment for symptomatic status (HR=2.29, p=0.02, CI 1.142 - 4.592) and (HR=2.286, p=0.028, CI 1.094 - 4.778). Outcome in low risk patients were not related to the symptomatic status for stroke and death (HR=2.484, p=0.148, CI 0.724 - 8.524), correspondingly for stroke. Conclusions: This is the first report identifying preprocedural myocardial infarction, first degree AV-block, SHR and SEC as predictors of stroke and stroke and death at 30 days postoperatively.