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dc.contributor.authorWallaert, Jessica B.
dc.contributor.authorCronenwett, Jack L.
dc.contributor.authorBertges, Daniel J.
dc.contributor.authorSchanzer, Andres
dc.contributor.authorNolan, Brian W.
dc.contributor.authorDe Martino, Randall R.
dc.contributor.authorEldrup-Jorgensen, Jens
dc.contributor.authorGoodney, Philip P.
dc.date2022-08-11T08:10:58.000
dc.date.accessioned2022-08-23T17:26:44Z
dc.date.available2022-08-23T17:26:44Z
dc.date.issued2013-07-01
dc.date.submitted2014-02-12
dc.identifier.citation<p> Wallaert JB, Cronenwett JL, Bertges DJ, Schanzer A, Nolan BW, De Martino R, Eldrup-Jorgensen J, Goodney PP; Vascular Study Group of New England. Optimal selection of asymptomatic patients for carotid endarterectomy based on predicted 5-year survival. J Vasc Surg. 2013 Jul;58(1):112-8. doi:10.1016/j.jvs.2012.12.056. <a href="http://dx.doi.org/10.1016/j.jvs.2012.12.056" target="_self">Link to article on publisher's site</a></p>
dc.identifier.issn0741-5214 (Linking)
dc.identifier.doi10.1016/j.jvs.2012.12.056
dc.identifier.pmid23478502
dc.identifier.urihttp://hdl.handle.net/20.500.14038/49707
dc.description.abstractOBJECTIVE: Although carotid endarterectomy (CEA) is performed to prevent stroke, long-term survival is essential to ensure benefit, especially in asymptomatic patients. We examined factors associated with 5-year survival following CEA in patients with asymptomatic internal carotid artery (ICA) stenosis. METHODS: Prospectively collected data from 4114 isolated CEAs performed for asymptomatic stenosis across 24 centers in the Vascular Study Group of New England between 2003 and 2011 were used for this analysis. Late survival was determined with the Social Security Death Index. Cox proportional hazard models were used to identify risk factors for mortality within the first 5 years after CEA and to calculate a risk score for predicting 5-year survival. RESULTS: Overall 3- and 5-year survival after CEA in asymptomatic patients were 90% (95% CI 89%-91%) and 82% (95% CI 81%-84%), respectively. By multivariate analysis, increasing age, diabetes, smoking history, congestive heart failure, chronic obstructive pulmonary disease, poor renal function (estimated glomerular filtration rate dependence), absence of statin use, and worse contralateral ICA stenosis were all associated with worse survival. Patients classified as low (27%), medium (68%), and high risk (5%) based on number of risk factors had 5-year survival rates of 96%, 80%, and 51%, respectively (P < .001). CONCLUSIONS: More than four out of five asymptomatic patients selected for CEA in the Vascular Study Group of New England achieved 5-year survival, demonstrating that, overall, surgeons in our region selected appropriate patients for carotid revascularization. However, there were patients selected for surgery with high risk profiles, and our models suggest that the highest risk patients (such as those with multiple major risk factors including age >/= 80, insulin-dependent diabetes, dialysis dependence, and severe contralateral ICA stenosis) are unlikely to survive long enough to realize a benefit of prophylactic CEA for asymptomatic stenosis. Predicting survival is important for decision making in these patients.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=23478502&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.jvs.2012.12.056
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAsymptomatic Diseases
dc.subjectCarotid Artery, Internal
dc.subjectCarotid Stenosis
dc.subject*Decision Support Techniques
dc.subject*Endarterectomy, Carotid
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectMultivariate Analysis
dc.subject*Patient Selection
dc.subjectProportional Hazards Models
dc.subjectRegistries
dc.subjectRisk Assessment
dc.subjectRisk Factors
dc.subjectSeverity of Illness Index
dc.subjectTime Factors
dc.subjectTreatment Outcome
dc.subjectUnited States
dc.subjectSurgery
dc.titleOptimal selection of asymptomatic patients for carotid endarterectomy based on predicted 5-year survival
dc.typeJournal Article
dc.source.journaltitleJournal of vascular surgery
dc.source.volume58
dc.source.issue1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/surgery_pp/134
dc.identifier.contextkey5111951
html.description.abstract<p>OBJECTIVE: Although carotid endarterectomy (CEA) is performed to prevent stroke, long-term survival is essential to ensure benefit, especially in asymptomatic patients. We examined factors associated with 5-year survival following CEA in patients with asymptomatic internal carotid artery (ICA) stenosis.</p> <p>METHODS: Prospectively collected data from 4114 isolated CEAs performed for asymptomatic stenosis across 24 centers in the Vascular Study Group of New England between 2003 and 2011 were used for this analysis. Late survival was determined with the Social Security Death Index. Cox proportional hazard models were used to identify risk factors for mortality within the first 5 years after CEA and to calculate a risk score for predicting 5-year survival.</p> <p>RESULTS: Overall 3- and 5-year survival after CEA in asymptomatic patients were 90% (95% CI 89%-91%) and 82% (95% CI 81%-84%), respectively. By multivariate analysis, increasing age, diabetes, smoking history, congestive heart failure, chronic obstructive pulmonary disease, poor renal function (estimated glomerular filtration rate dependence), absence of statin use, and worse contralateral ICA stenosis were all associated with worse survival. Patients classified as low (27%), medium (68%), and high risk (5%) based on number of risk factors had 5-year survival rates of 96%, 80%, and 51%, respectively (P < .001).</p> <p>CONCLUSIONS: More than four out of five asymptomatic patients selected for CEA in the Vascular Study Group of New England achieved 5-year survival, demonstrating that, overall, surgeons in our region selected appropriate patients for carotid revascularization. However, there were patients selected for surgery with high risk profiles, and our models suggest that the highest risk patients (such as those with multiple major risk factors including age >/= 80, insulin-dependent diabetes, dialysis dependence, and severe contralateral ICA stenosis) are unlikely to survive long enough to realize a benefit of prophylactic CEA for asymptomatic stenosis. Predicting survival is important for decision making in these patients.</p>
dc.identifier.submissionpathsurgery_pp/134
dc.contributor.departmentDepartment of Surgery
dc.source.pages112-8


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