Abstract TMP24: Duration of Asymptomatic Status and Outcomes Following Endarterectomy and Stenting in the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST)
Introduction: Inclusion of asymptomatic patients in randomized trials comparing revascularization to medical therapy has been questioned if they have been previously symptomatic.
Hypothesis: Duration of asymptomatic status is not associated with better outcomes following endarterectomy (CEA) or stenting (CAS).
Methods: Patients in CREST were classified as asymptomatic if they had not had a TIA or stroke ipsilateral to the study artery within 6 months prior to randomization. We compared those patients who had always been asymptomatic (AA) to those who had been previously symptomatic (PS) ≥ 6 months prior to randomization. Proportional hazards models adjusting for age and treatment were used to assess risk of 30-day stroke or death (S+D), and risk of any 30-day S+D plus ipsilateral stroke at 4 years by asymptomatic status
Results: Among the 1056 asymptomatic patients who received the assigned procedure within 30 days of randomization, 977 (93%) were AA and 79 (7%) were PS. There was no difference in the 30-day and 4 year outcomes (Table).
Conclusion: In CREST, 93% of the asymptomatic patients were always asymptomatic. Similar outcomes for the previously symptomatic patients (7%) supports the inclusion of such patients in randomized trials comparing CEA and CAS to medical treatment.
Author Disclosures: W.S. Moore: None. J.H. Voeks: None. G.S. Roubin: Ownership Interest; Modest; Essential Medine. Consultant/Advisory Board; Modest; The Medicines Company. Other; Modest; Royalties: Cook inc.. W.M. Clark: None. V.J. Howard: None. M.R. Jones: None. T.G. Brott: None.
- © 2016 by American Heart Association, Inc.