Risk score for peri-interventional complications of carotid artery stenting.
OBJECTIVE
Routinely available independent risk factors for the peri-interventional outcome of patients undergoing elective carotid artery stenting (CAS) are lacking. The rationale of the study was to create a risk score identifying high-risk patients.


METHODS
We prospectively enrolled 606 consecutive patients assigned to CAS at a secondary care hospital. Various biochemical, clinical, and lesion-related risk factors were prospectively defined. The primary end point reflecting periprocedural complications encompassed minor and major stroke, nonfatal myocardial infarction and all-cause mortality within 30 days.


RESULTS
Three percent of patients (n=18) experienced a nonfatal minor (n=13) or major (n=5) stroke. 1.3% of patients (n=8) died from fatal stroke (n=4) or other causes (n=4). No myocardial infarction was observed within 30 days after stenting. Multivariable analysis revealed diabetes mellitus with inadequate glycemic control (HbA1c > 7%), age > or = 80 years, ulceration of the carotid artery stenosis, and a contralateral stenosis > or = 50% as independent risk factors. A risk score formed with these variables showed a superior predictive value (C-statistic = 0.73) compared with single risk factors. The presence of 2 or more of these risk factors identified patients with a risk of 11% for a periprocedural complication compared with 2% in patients with a score of 0 or 1.


CONCLUSIONS
In patients undergoing elective CAS, a risk score based on routinely accessible variables was able to identify patients at high-risk for atherothrombotic events and all-cause death within 30 days after the intervention.
Hofmann
Robert
R
Cardiovascular Division, City Hospital Linz, Austria, A-4020 Linz, Krankenhausstr. 9. robert.hofmann@akh.linz.at
Niessner
Alexander
A
Kypta
Alexander
A
Steinwender
Clemens
C
Kammler
Jürgen
J
Kerschner
Klaus
K
Grund
Michael
M
Leisch
Franz
F
Huber
Kurt
K
D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000601:surgery; D016893:Carotid Stenosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000209:etiology