Abstract WP134: Treatment of Internal Carotid Artery Stenosis With Heart Disease in Japan; J-ASPECT Study

Abstract

Background: It is well-known that patients with carotid artery stenosis often merge the heart disease, including coronary artery disease. In Japan, there is no nationwide report about it. Here through J-ASPECT study that utilizes the Japanese Diagnosis Procedure Combination (DPC) and receipt database, we examined the carotid artery treatment complicated with heart disease in Japan. Object and method: Object: Of the 1,369 certified training institutions in Japan, 847 hospitals responded to a questionnaire survey. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2012 and March 31, 2013 were obtained from the Japanese Diagnosis Procedure Combination database. Method: During the treated surgery code, cases of carotid endarterectomy (CEA, K6092), and carotid artery stenting (CAS, K609-2) were extracted. Patients with heart disease was defined when ICD-10 codes for heart disease were recorded on admission as comorbidity. We compered the mortality rate, modified Rankin Scale at discharge, period of hospitalization, medical expenses, and postoperative complications. Result: CEA was carried out in 1655 patients and CAS was done in 2533 patients. Percentage of comorbidity with heart disease was 30% in CEA, and 25% in CAS. Treatment for carotid artery stenosis with heart disease tended to select CEA (p <0.001). Coronary artery disease accounted for 60-70% of merged heart disease. The presence of heart disease did not affect the prognosis of CEA patients. On the other hand, although the actual number of patients is small, mortality within 7 days after surgery in CAS patients, patients with heart disease, was 4-fold higher than the patients without heart disease. Conclusion: In this report, we clarified the current status of the carotid artery treatment with heart disease in Japan. Our study showed the excellent surface of the carotid artery treatment in Japan to indicate the equal treatment results in cases with and without heart disease.