Key result
Complete coronary revascularization was an independent predictor of survival in patients undergoing carotid artery stenting (HR 1.978), with median survival being unattainable compared to 38 months for incomplete revascularization.
Why the study?
The study was conducted to analyze prognostic factors in patients after carotid artery stenting.
What are the independent prognostic factors for survival in patients undergoing carotid artery stenting with concomitant coronary disease?
Cohort (n=329)
No
What are the independent prognostic factors for survival in patients undergoing carotid artery stenting with concomitant coronary disease?
Hazard Ratio: 1.978 (95% CI 1.035–3.782)
p-value: p=0.039
Survival after carotid artery stenting is primarily limited by concomitant coronary artery disease and underlying cardiac pathology, suggesting that staged revascularization may improve prognosis.
May support staged complete revascularization in carotid stenting; leaves open confirmation via randomized trials.
AIM: The aim of the study was to analyze the prognostic factors in patients after carotid artery stenting (CAS). METHODS: In 329 patients after CAS, the median survival (MS) and overall survival (OS) were calculated for a follow-up period of 2–101 months. All patients underwent coronary angiography before carotid stenting and, if indicated, coronary revascularization. Four groups of factors were analyzed: Carotid disease, coronary artery disease (CAD), underlying cardiac pathology, and concomitant diseases. RESULTS: MS in all patients was 86 months, OS at 1, 3, 5, and 9 years was - 94%, 85%, 73%, and 51%, respectively. Event free survival was 85 months. Log Rank-Mantel-Cox analysis demonstrated significantly reduced MS in 21 tested factors, most of them related to CAD. Two-step multifactorial Cox regression analysis defined only 7 of them as independent prognostic factors for the survival of patients after CAS: Left main stenosis, complete revascularization, late myocardial infarction, stroke, age over 70 years, valvular disease, and carotid score. CONCLUSION: Survival of patients after CAS is limited mainly by CAD and underlying cardiac pathology. Staged revascularization treatment strategy may improve the prognosis and survival of patients with both carotid and coronary disease.
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Goranov et al. (2021) conducted a cohort in Carotid artery stenosis with concomitant coronary artery disease (n=329). Complete coronary revascularization vs. Incomplete coronary revascularization was evaluated on Overall survival (HR 1.978, 95% CI 1.035-3.782, p=0.039). Complete coronary revascularization was an independent predictor of survival in patients undergoing carotid artery stenting (HR 1.978), with median survival being unattainable compared to 38 months for incomplete revascularization.
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