A Validated Risk Score to Predict Outcomes after Carotid Stenting

Hoke, M.; Ljubuncic, Elmir; Steinwender, Clemens; Huber, Kurt; Minar, Erich; Koppensteiner, Renate; Leisch, F; Dick, Petra; Kerschner, Klaus; Schillinger, Martin; Hofmann, Robert; Niessner, Alexander

doi:10.1161/circinterventions.112.972430

Cited by 14 publications

(6 citation statements)

References 24 publications

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“…Coagulopathy was also identified as an independent risk factor for acute renal failure and multiorgan failure (36) . PT was found to be the independent predictor of long-term mortality in patients undergoing carotid stenting (37) . In that study, PT remained a significant predictor for mortality after excluding patients with (stopped) oral anticoagulation.…”

Section: Discussionmentioning

confidence: 88%

Prognostic Value of Prothrombin Time in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Kırış¹,

Vatansever²,

Yazıcı³

et al. 2018

Kosuyolu Heart Journal

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Introduction: There are some studies regarding the prognostic value of coagulation abnormalities both in heart failure and acute pulmonary embolism patients. However, it is unclear whether prothrombin time (PT) at presentation will be associated with long-term mortality in acute coronary syndrome (ACS) patients not on anticoagulant therapy. Thus, we investigated the prognostic role of initial PT in such patients. Patients and Methods: A total of 1100 consecutive patients with ACS undergoing percutaneous coronary intervention (PCI) who were not receiving anticoagulant therapy were included in the study, retrospectively. PT was measured on admission in these patients before anticoagulation therapy. The study population was divided into three groups based on the PT values: A high-PT group (PT ≥ 14 sec, n= 50), intermediate-PT group (12.5 < PT < 14 sec, n= 169), and low-PT group (PT ≤ 12.5 sec, n= 881). The primary end point was all-cause death during the median follow-up of 30.5 months. Results: The rate of the primary end point was 15% in the low-PT group, 27% in the intermediate-PT group, and 52% in the high-PT group (p< 0.001). For long-term mortality, a significantly higher mortality risk was observed in high-PT group (HR: 2.648, 95% CI: 1.590-4.410, p< 0.001) compared with the others group in multivariate analysis. The addition of PT to a multivariable model that included the left ventricular ejection fraction, histories of diabetes mellitus and stroke, age, hemoglobin, creatinine, white blood cell count, total bilirubin levels and Killip class led to a significant net reclassification improvement (NRI) of 26.7% (p< 0.001) and an integrated discrimination improvement of 0.022 (p= 0.001). Conclusion: Our findings suggest that prolonged initial PT in the absence of anticoagulant therapy can be associated with all-cause mortality in ACS patients who were undergoing PCI. In addition, PT may be used to identify the high-risk patients with ACS.

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Section: Discussionmentioning

confidence: 88%

Prognostic Value of Prothrombin Time in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Kırış¹,

Vatansever²,

Yazıcı³

et al. 2018

Kosuyolu Heart Journal

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“…Most studies to date have focused on the short-term outcomes of CAS patients, and long-term survival data are not numerous in the literature. In this study, the annual mortality rate was 6.4%, compared to 2.3% in the TARGET-CAS trial (mean age at CAS 65 years, mean follow-up: 23 months) [ 16 ], 3.4% in the multi-center European study (mean age at CAS 72 years, mean follow-up: 32 months) [ 17 ], 3.6% in the Italian study (mean age at CAS 71.5 years, mean follow-up 33 months) [ 18 ], and 5.4% in the Austrian trial (Linz group: mean age at CAS 71 years, median follow-up: 6.5 years) [ 19 ]. These comparisons suggest that the patients included in our study were at high risk for long-term survival.…”

Section: Discussionmentioning

confidence: 99%

“…Hoke et al . stratified CAS patients into tertiles according to weighted risk score and observed 5-year survival of 91%, 73%, and 48% in the first, second, and third tertiles, respectively [ 19 ]. Our patients had a 5-year survival rate of 70% and 76% in the MVD and non-MVD groups, respectively, which correlates with the second tertile of the above-mentioned study.…”

Section: Discussionmentioning

confidence: 99%

Impact of coexisting multivessel coronary artery disease on short-term outcomes and long-term survival of patients treated with carotid stenting

Veselka¹,

Špaček²,

Horváth³

et al. 2016

aoms

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IntroductionSystemic atherosclerosis can result in both coronary artery disease (CAD) and carotid artery disease. Recently it has been shown that patients with CAD have a higher incidence of microembolization during carotid artery stenting (CAS), and it has been hypothesized that they could be at higher risk in this intervention.Material and methodsWe retrospectively evaluated an institutional registry with 437 consecutive patients who underwent coronary angiography and CAS to evaluate their short-term outcomes and long-term survival with regard to the presence of coexisting multivessel coronary artery disease (MVD).ResultsWe performed 220 CAS procedures in MVD patients and 318 CAS procedures in non-MVD patients. The incidence of in-hospital CAS-related adverse events was 2.7% and 2.5% in the MVD and non-MVD groups, respectively (p = 0.88). At 30 days, there was no significant difference between the groups in terms of the number of patients with adverse events (hierarchically death/stroke/myocardial infarction; 8.8% vs. 5.5%; p = 0.18). The median duration of follow-up was 4.23 years. Survival free of all-cause mortality at 1, 3 and 5 years was 90% (95% CI: 86–94%), 79% (95% CI: 73–85%) and 70% (95% CI: 64–77%), and 92% (95% CI: 89–95%), 85% (95% CI: 80–90%) and 76% (95% CI: 70–82%) for the MVD and non-MVD groups (p = 0.02), respectively.ConclusionsThese results suggest that patients with MVD combined with carotid artery disease are probably not at higher risk of early post-CAS adverse clinical events, but they have significantly worse long-term survival rates.

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“…Likelihood of brain damage after CAS procedure depends on various factors, as data from various researchers indicate. Some investigators have shown the connections of early post procedural brain ischemic abnormalities with male gender [32,40], others -with older age [41], yet otherswith concomitant illnesses such as ischemic cardiac disease or diabetes [42], with certain peculiarities of anatomy and physiology of the body and the type of the aortic arch [33,34], and also with such risk factors as overweight/obesity, dyslipidemia and smoking [39,43]. Results of our study confirm other researchers' findings that the type of the aortic arch and application of certain systems of protection during the CAS procedure may determine worse early results after the CAS procedure and a more frequent worse outcome [44].…”

Section: Discussionmentioning

confidence: 99%

Early ischemic brain lesions after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging study

Misonis¹,

Palionis²,

Tamošiūnas³

et al. 2013

Seminars in Cardiovascular Medicine

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Summary Aim: The aim of the paper is to evaluate the appearance of the new early ischemic lesions in the brain after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging, and their relationship with clinical and procedural factors. Methods: Carotid artery stenting (CAS) procedures performed by a single interventional cardiologist in years November 2006 to January 2013 were evaluated retrospectively. In total, 227 procedures for 211 patients (mean age 69.8 ± 8.5 years) were performed, from which 171 (75.3%) for male and 56 (24.7%) for female patients. Seventy-two (34.1%) patients had symptomatic stenosis of carotid artery. The following protection systems to avoid the distal microembolism were used during the CAS: (1) Filters: FilterWire EZ (Boston Scientific Corporation); Emboshield NAV (Abbott Vascular); SpideRX (EV3); Defender (Medtronic); FiberNet Filter (Invatec-Medtronic); (2) Occlusion MoMa Baloon System (Invatec-Medtronic). Acute ischemic damages of the brain before and after CAS procedure were diagnosed using magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) sequences. Sixty-five (30.8%) patients underwent MRI test. Exact and asymptomatic χ2 criteria were applied for testing the hypothesis of inter-dependency of the symptoms. Results: Forty-six (70.8%) patients had new ischemic foci in the brain on MRI DWI after CAS procedures. Among those patients, focal damage of the brain was diagnosed in 36 (78.3%) cases; linear damage of the brain - in 9 (19.6%) patients; ipsilateral damage of the brain - in 37 (80.4%) patients; bilateral damage of the brain - in 16 (34.8%) patients, 38 (82.6%) patients were diagnosed with forebrain damage; 4 (8.7%) patients were diagnosed with damage of brainstem; 5 (10.9%) patients were diagnosed with cerebellum damage. Clinical symptoms of brain damage were diagnosed only for 2 (4.3%) patients. Focal damage of the brain was significantly less frequent only for aortic arch type 1, if compared with aortic arch type 2 and 3: 64.3%, 93.3% and 100.0%, respectively (p < 0.05). Focal damage of the brain occurred least in patients (28.6%) with Emboshield NAV protection type, if compared to other types of protection (71.4-100.0%). Linear >10mmbrain damage was less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ipsilateral ischemic brain damage also occurred less frequent when using Emboshield NAV protection type; bilateral damage occurred less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ischemic forebrain damage was also diagnosed less often in patients for whom protection type FilterWire EZ and Emboshield NAV was applied. Conclusions: Most frequent findings by MRI after CAS procedures were focal, ipsilateral and forebrain damage (about 80%), but less than 5% patients had clinical symptoms. In the case of aorta arch type 1 focal ischemic damage of the brain was significantly less frequent, then in aortic arch type 2 and 3. The localization and extent of brain damage was associated with the type of protection systems that have been used.

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A Validated Risk Score to Predict Outcomes after Carotid Stenting

Cited by 14 publications

References 24 publications

Prognostic Value of Prothrombin Time in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Prognostic Value of Prothrombin Time in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Impact of coexisting multivessel coronary artery disease on short-term outcomes and long-term survival of patients treated with carotid stenting

Early ischemic brain lesions after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging study

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