Abstract T MP35: Difference in Long-Term Survival After Carotid Endarterectomy Between Standard and High Risk Patients

Abstract

Background: Large randomized controlled trials have shown that carotid endarterectomy (CEA) in carefully selected patients reduced the risk of stroke and death compared to existing medical therapy alone. Early and long-term mortality after CEA and the predictive factors of major adverse events (MAEs) should be considered when deciding on this procedure. Methods: We enrolled the patients who underwent consecutive CEA procedures. Perioperative (≤30 days) and long-term outcome in standard-risk (SR) and high-risk (HR) procedures was obtained. MAE was defined as the occurrence of stroke, death, or myocardial infarction out to 174 months. Results: A total of 247 patients underwent 271 CEA procedures. Of these, 157 patients had SR and 90 patients had HR. The 30-day rate of death, myocardial infarction, or stroke was 4.5% among all patients (3.2% for SR vs. 6.7% for HR). Kaplan-Meier analysis showed significant lower survival rate in HR patients (p=0.002). At 5 year, survival rate was 68.1% in SR patients and 28.6% in HR patients, respectively. The most single significant predictor of MAE was coronary artery disease (HR, 3.1; 95% CI, 1.8-5.5). Conclusion: In this study of patients underwent CEA, a substantial reduction in long-term survival was observed in high risk patients compared with standard risk patients. Therefore, evaluation and treatment for coronary disease is strongly recommended before and after CEA.