Long-term Survival after Carotid Endarterectomy in a Population with a Low Coronary Heart Disease Fatality: Implications for Decision Making.
BACKGROUND
According to the current guidelines, long-term survival is an important factor influencing decision making in patients with severe asymptomatic carotid stenosis. Nevertheless, data are lacking for populations with a low incidence of coronary heart disease, the main cause of death among these patients. We aimed to assess the long-term survival after carotid endarterectomy (CEA) in a Mediterranean hospital.


METHODS
Retrospective analysis was conducted of 291 consecutive patients (main age 69 years, 78.7% men) who underwent a CEA for symptomatic (n = 147, 50.5%) or asymptomatic (n = 144, 49.5%) carotid stenosis in 2005-2014 at the Hospital del Mar (Barcelona, Spain). A Kaplan-Meier life table was done and a multivariable Cox regression model was built for the analysis of the long-term survival-associated risk factors.


RESULTS
The immediate combined mortality and/or neurological morbidity rate was 2.7%. The mean follow-up was 55 months (complete in 99.7%). During follow-up 62 patients (21.3%) died, being cancer the most frequent cause (35.5%). Cumulative 3- and 5-year survival rates were 89% and 81%, respectively. Independent risk factors (Cox regression) related to survival included age (hazards ratio [HR] 1.09, P < 0.001), an American Society of Anesthesiologists class IV score (HR 4.04, P = 0.015), and the preoperative hemoglobin value (HR 0.73, P < 0.001). The discrimination of the resulting model was 0.719 (95% confidence interval 0.644-0.794). Previous symptomatic carotid stenosis was not related to long-term survival.


CONCLUSIONS
The long-term survival of patients submitted to CEA in our series lies in the lower limit of the estimated range by other groups and is markedly related to cancer. Our study suggests that predictive models for survival are influenced by regional characteristics.
Angiology and Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Carlos
C
Ruiz-Carmona
Angiology and Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: diazdurancarles@gmail.com.
Carles
C
Diaz-Duran
Angiology and Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Nerea
N
Sevilla
Neurology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Elisa
E
Cuadrado
Angiology and Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Albert
A
Clará
D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality*; D003661:Decision Support Techniques; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome