title: Clinical predictors of major adverse cardiovascular events during long-term follow-up after carotid endarterectomy.
abstract: BACKGROUND
  Those patients who undergo a carotid endarterectomy (CEA) will present a higher cardiovascular risk during follow-up than the general population. The objective of this study was to determine the prognostic factors and validate the accuracy of 3 cardiovascular risk scores as predictors of major adverse cardiovascular events (MACEs) during long-term follow-up after CEA.
  
  
  METHODS
  Observational retrospective follow-up study with 416 CEAs conducted consecutively in 385 patients from 1994 to 2011. The primary end point was MACE, single event including myocardial infarction, stroke, and cardiovascular death. Preoperative risk factors and medical treatment at discharge were collected. A general cardiovascular risk score, the Revised Cardiac Risk Index (RCRI), was used, and 2 scores specific for CEA (Halm and Tu). Descriptive analysis and Cox regression were conducted. Informed consent from patients was obtained and approval by the ethics committee.
  
  
  RESULTS
  The median follow-up was 4.94 years. MACEs appeared in 22.1% (95% confidence interval [CI], 18.0-26.2%) of the series during follow-up. The MACEs rate at 1 year, 3 years, and 5 years, was 3.1%, 9.3%, and 15.8%, respectively. In the Cox regression model, the MACE predictor variables were: the presence of peripheral artery disease (hazard ratio [HR], 1.69; 95% CI, 1.06-2.70) and RCRI (HR,1.61; 95% CI, 1.04-2.50). The RCRI area under the curve for predicting events, with a 2.5 cutoff point, was 0.59 with 85.9% sensitivity and a positive predictive value of 25.2%.
  
  
  CONCLUSIONS
  Peripheral artery disease and high RCRI have an independent effect on predicting MACEs. The 3 different scores have a low ability for predicting MACEs during long-term follow-up.
authors.affiliation: Angiology and Vascular Surgery Unit, Instituto de Investigación Biomédica de A Coruña (Institute for Biomedical Research, A Coruña) (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain. Electronic address: vilavasc@hotmail.com.
authors.forename: Jorge
authors.initials: J
authors.lastname: Vilariño-Rico
authors.affiliation: Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña (Institute for Biomedical Research, A Coruña) (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pita-Fernández
authors.affiliation: Angiology and Vascular Surgery Unit, Instituto de Investigación Biomédica de A Coruña (Institute for Biomedical Research, A Coruña) (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain.
authors.forename: Ramón Joaquín
authors.initials: RJ
authors.lastname: Segura-Iglesias
mesh_terms: D000368:Aged; D019540:Area Under Curve; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D058729:Peripheral Arterial Disease / Q000150:complications; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome