title: Rates and predictors of 5-year survival in a national cohort of asymptomatic elderly patients undergoing carotid revascularization.
abstract: BACKGROUND
  Current American Heart Association guidelines recommend carotid revascularization for asymptomatic patients on the basis of life expectancy.
  
  
  OBJECTIVE
  To determine the rates and predictors of 5-year survival in elderly patients with asymptomatic carotid artery stenosis who underwent either carotid artery stent placement (CAS) or carotid endarterectomy (CEA).
  
  
  METHODS
  The rates of 5-year survival were determined by use of Kaplan-Meier survival methods in a representative sample of fee-for-service Medicare beneficiaries ≥65 years of age who underwent CAS or CEA for asymptomatic carotid artery stenosis with postprocedural follow-up of 3.4 ± 1.7 years. Cox proportional hazards analysis was used to assess the relative risk of all-cause mortality for patients in the presence of selected comorbidities, including ischemic heart disease, chronic renal failure, and atrial fibrillation, after adjustment for potential confounders such as age, sex, race/ethnicity, and procedure type.
  
  
  RESULTS
  A total of 22,177 patients with asymptomatic carotid artery stenosis were treated with either CAS (n = 2144) or CEA (n = 20,033). The overall estimated 5-year survival rate (±SE) was 95.3 ± 0.00149; it was 95.5% and 93.8% in patients treated with CEA and CAS, respectively. After adjustment for potential confounders, relative risk of all-cause 5-year mortality was significantly higher among patients with atrial fibrillation (relative risk, 1.8; 95% confidence interval, 1.5-2.1) and those with chronic renal failure (relative risk, 2.1; 95% confidence interval, 1.7-2.6).
  
  
  CONCLUSIONS
  Risks and benefits must be carefully weighed before carotid revascularization in elderly patients with asymptomatic carotid artery stenosis who have concurrent atrial fibrillation or chronic renal failure.
authors.affiliation: Zeenat Qureshi Stroke Institute and Department of Cerebrovascular Diseases, CentraCare Health, St. Cloud, Minnesota.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.forename: Saqib A
authors.initials: SA
authors.lastname: Chaudhry
authors.forename: Mushtaq H
authors.initials: MH
authors.lastname: Qureshi
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality; D008297:Male; D006278:Medicare; D016016:Proportional Hazards Models; D018570:Risk Assessment; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States