This Article Full Text Full Text (PDF) All Versions of this Article: 39/11/2966    most recent STROKEAHA.108.516062v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chaturvedi, S. Articles by Raje, N. Search for Related Content PubMed PubMed Citation Articles by Chaturvedi, S. Articles by Raje, N. Related Collections Risk Factors Carotid endarterectomy

(Stroke. 2008;39:2966.)
© 2008 American Heart Association, Inc.

Original Contributions

Higher Risk Factor Burden and Worse Outcomes in Urban Carotid Endarterectomy Patients

Seemant Chaturvedi, MD; Ramesh Madhavan, MD; Sunitha Santhakumar, MD; Maysaa Mehri-Basha, MD Nikita Raje, MD

From the Stroke Program and the Department of Neurology, Wayne State University, Detroit, Mich.

Correspondence to Seemant Chaturvedi, MD, Stroke Program and the Department of Neurology, Wayne State University, 8C-UHC, 4201 St Antoine, Detroit, MI 48201. E-mail SChaturv{at}med.wayne.edu

Background and Purpose— Previous multicenter carotid endarterectomy (CEA) studies had screening criteria for patient comorbidities and very few blacks. We assessed the hypothesis that CEA results from two urban hospitals would approximate those of the previous multicenter trials.

Methods— A retrospective chart review was completed at two urban hospitals for CEA procedures done in 2003 and 2004. Demographic information and past medical history was recorded. In hospital perioperative complications (stroke or myocardial infarction [MI]) were noted. We calculated an expected perioperative stroke rate based on trial figures and our proportion of symptomatic and asymptomatic patients.

Results— Patients in our cohort had significantly higher rates of hypertension, diabetes, smoking, black race, and elderly status compared to previous trials. The expected perioperative stroke was 3.1%, and the observed stroke rate was 4.7% (P=0.36). Observed rates of MI (6.7%, P<0.001)) and stroke or MI (11.3%, P<0.0001) were higher than expected based on the previous trials. The stroke or MI rate in black subjects was higher (15.4% versus 5.6%, P=0.065) and this was significant at the hospital with lower CEA volume.

Conclusions— In two urban hospitals, CEA results were significantly worse than previous trials. Patient selection is likely to play a role because our cohort had higher numbers of hypertensives, diabetics, smokers, blacks, and elderly patients. Clinicians need to carefully consider the risk/benefit ratio of CEA in urban patients because our study shows that these patients have a large number of medical comorbidities and worse outcomes after CEA.

Key Words: carotid endarterectomy • carotid stenosis • blacks