Risk of adverse vascular events after carotid endarterectomy: a ten-year follow-up

Abstract

Significant atherosclerotic stenosis of the carotid arteries can provoke ischemic stroke and is one of the factors considered when assessing eligibility for carotid endarterectomy (CEE). Objective. To identify risk factors for the development of adverse vascular events (AVE) after undergoing CEA in the medium-term (5 and 7 years) and long-term (10 years) follow-up. Design and methods. In total, 257 patients underwent reconstructive surgery on the carotid arteries in the period from 2007 to 2010, and at 1–1,5-year follow-up after the operation, we assessed the regularity of taking prescribed medications, vital activity according to the Barthel index, FIM scale, scales of anxiety, depression and mental status assessment (MMSE); and lipid profile. Long-term endpoints (death or acute cerebrovascular accident) were registered for 5-10 years after surgery. During follow-up, 129 patients dropped out at different stages of the study, 47 died during the study period (30 died from cardiovascular disease), 37 had a stroke. Cox’s proportional hazards model was used as a tool for survival analysis. Results. Older age (over 60 years) at the time of surgery increases the risk of death and the onset of AVE in the period up to 5, 7 and 10 years after surgery by 1,106 (1,245) times, 1,137 (1,247) and 1,182 (1,182) times, respectively; smoking increases the risk of death within 5, 7 and 10 years by 2,963, 2,419 and 2,44 times; the presence of diagnosed depression in accordance with the HADS scale (part II) increases the risk of death after CEE in the period up to 5 years by 1,176 times. An increase in the atherogenicity coefficient by each unit relative to the average value (3,0) leads to an increase in the risk of death or the onset of AVE in the period of 5 years after the operation by 1,915 (2,159) times, in the period of 7 years — by 1,966 (2,183), and in 10 years — by 1,991 (2,264) times. Each additional point of the Barthel index relative to the mean value (95 points) reduced the risk of death or the onset of AVE in a 5-year period by 7 (9,5) % compared to the baseline, in 7 and 10-year periods by 4,5 (9) and 10 (10,5) %, respectively. A decrease in adherence to drug therapy increases the risk of death in the period up to 7 years — by 1,406 times, in 10 years — by 1,426 times. The lack of regular intake of acetylsalicylic acid increases the risk of AVE in the 5-year period after the operation by 3,278 times, in 7 years — by 2,892 times, in 10 years — by 2,837 times; each additional point of the MMSE scale from the mean value (28 points) reduces the risk of death in the period up to 10 years after CEE compared with the baseline risk by 1,51 times, the female gender increases the risk of AVE in the period up to 5, 7 and 10 years by 4,762, 3,952 and 3,484 times, respectively. Conclusions. Risk factors for the development of AVE after long-term follow-up after CEE have been identified, which can be used for the personalized preventive measures.