Stroke, Vol 24, 1285-1291, Copyright © 1993 by American Heart Association
DC McCrory, LB Goldstein, GP Samsa, EZ Oddone, PB Landsman, WS Moore and DB Matchar
BACKGROUND AND PURPOSE: Carotid endarterectomy has been shown to be
beneficial in patients with high-grade carotid stenosis and ipsilateral
transient ischemic attack or stroke. This benefit will be realized only if
the operation is performed safely. We sought to determine the extent to
which clinically significant adverse events occurring after carotid
endarterectomy can be predicted from clinical data available before
surgery. METHODS: Eleven hundred sixty patients were randomly selected from
all patients who underwent carotid endarterectomy and were discharged
during the calendar years 1988, 1989, and 1990 in 12 academic medical
centers in 10 states. Clinical data abstracted from hospital charts were
analyzed retrospectively. A model was developed and validated to predict
the occurrence of stroke, myocardial infarction, or death during the
postoperative period of hospitalization. RESULTS: Eight patients (6.9%)
suffered at least one adverse event. Rates for individual complications
were as follows: death, 1.4%; nonfatal stroke, 3.4%; nonfatal myocardial
infarction, 2.1%; and nonfatal stroke or death, 4.8%. Significant
predictors of adverse events were age 75 years or older, symptom status
(ipsilateral symptoms versus asymptomatic or nonipsilateral symptoms),
severe hypertension (preoperative diastolic blood pressure of greater than
110 mm Hg), carotid endarterectomy performed in preparation for coronary
artery bypass surgery, history of angina, evidence of internal carotid
artery thrombus, and internal carotid artery stenosis near the carotid
siphon. The presence of two or more of these risk factors was associated
with a nearly twofold increase in risk of an adverse event (relative risk,
1.7; 95% confidence interval, 1.0 to 3.0). CONCLUSIONS: Clinical data can
be used to stratify patients undergoing carotid endarterectomy according to
risk of postoperative in-hospital stroke, myocardial infarction, or death.
ARTICLES
Predicting complications of carotid endarterectomy
Center for Health Policy Research and Education, Durham, NC 27710.
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