Abstract 68: The Effect Of Pre-existing Atrial Fibrillation On In-hospital Outcomes In Patients Undergoing Carotid Endarterectomy Or Stent Placement In General Practice

Abstract

Background: Atrial fibrillation (AF) is a relatively common comorbid condition among patients who undergo carotid endarterectomy (CEA) and carotid artery stent placement (CAS); however the outcomes of patients with AF undergoing CAS have not been fully examined. We sought to investigate the impact of AF on in-hospital outcomes of CEA and CAS in general practice. Methods: We analyzed the data from the Nationwide Inpatient Sample (NIS), which is representative of all admissions in the United States from 2005 to 2009. The primary end point was postoperative stroke, cardiac complications, postoperative mortality, and composite of these endpoints. Multivariate regression analysis was performed to determine the 1/. the association of AF (compared to without AF); and 2/. the association of CEA (compared with CAS) with the occurrence of postoperative stroke, cardiac complication or death. Covariates included in the logistic regression were patient’s gender, age, ethnicity, comorbid conditions, symptom status (symptomatic vs asymptomatic status), and hospital characteristics. Results: Of the total 672,074 patients who underwent CAS or CEA, 8.8% of the procedures were performed in patients with AF. For patients undergoing CEA, AF was associated with an increased risk of postoperative stroke (P<0.0001; OR, 1.57: 95% CI, 1.32-1.86) but not in patients undergoing CAS. The relative risk of composite endpoint of postoperative stroke, cardiac complications, and mortality was increased in patients with AF undergoing CAS (OR 1.43, 95% CI 1.18-1.74) and those undergoing CEA (OR 3.18, 95% CI 2.89-3.49). After adjustment for potential confounders, the odds of composite endpoint of postoperative stroke, cardiac complications, and mortality (OR, 1.31, 95% CI 1.08 - 1.59) were significantly higher among patients who underwent CEA (compared with those who underwent CAS). An inverse relationship was seen in patients without AF in whom the composite endpoint was significantly lower in patients undergoing CEA. Conclusion: Our analysis suggests that almost 10% of CAS and CEA are performed in patients with AF in general practice, and higher rates of adverse events are observed among these patients particularly those undergoing CEA.