Key result
Patients with prior carotid endarterectomy had a 4.4-fold higher risk of acute myocardial infarction compared with population controls (P=0.002).
Why the study?
Does a history of carotid endarterectomy for stenosing carotid artery disease increase the long-term risk of death and atherothrombotic events compared to population controls?
Cohort (n=801)
Does a history of carotid endarterectomy for stenosing carotid artery disease increase the long-term risk of death and atherothrombotic events compared to population controls?
Hazard Ratio: 4.4
p-value: p=0.002
Patients with a history of carotid endarterectomy have a significantly higher long-term risk of acute myocardial infarction and death compared to population controls, highlighting the need for aggressive systemic cardiovascular risk reduction.
Prior carotid endarterectomy may warrant closer MI surveillance; leaves open whether intensified prevention reduces events in this population.
BACKGROUND: Atherosclerosis affects several vascular trees systemically and though surgical plaque removal diminishes the risk of stroke in patients with carotid stenosis, they still face a risk of other atherothrombotic complications like myocardial infarction and premature death. AIMS AND/OR HYPOTHESIS: This study was designed to reveal the long-term risk of death and atherothrombotic events following carotid endarterectomy. METHODS: Eighty-nine previously (1997-2000) endarterectomized carotid patients (56-92 years) were followed up to 15·2 years. Causes of death, cardiovascular events (stroke, transient ischemic attack, acute myocardial infarction), comorbidities, and medications were recorded and analyzed by Cox regression analysis. Four population controls and four controls with coronary disease (n = 712) were selected for each case from a population cohort for age- and gender-matched analysis. RESULTS: At the end of follow-up, 41 (44·6%) patients had died and 48 were alive. Ten patients (24,4%) died due to acute myocardial infarction and one (2,4%) due to stroke. Nineteen (21%) patients had an acute myocardial infarction, 12 (13%) had a stroke, 13 (15%) had a transient ischemic attack, and 5 (6%) had other atherothrombotic events. The risk of death was 5·7-fold in diabetics (P < 0·001) and 3·9-fold in smokers (P < 0·001). Patients who did not use statins had 5·0-fold, and irregular users 3·3-fold risk of death compared with active users (P = 0·005 and P = 0·001, respectively). The major factors associated with acute myocardial infarction were diabetes (6·0-fold risk, P = 0·004), bilateral carotid disease (3·5-fold risk, P = 0·014), and lack of statin use (4·4-fold risk, P = 0·038). Compared with population controls, carotid patients had a 4·4-fold risk of acute myocardial infarction (P = 0·002). CONCLUSIONS: Endarterectomized carotid patients have a high risk of acute myocardial infarction and death, and need an intensified cardiovascular disease-risk-lowering treatment. Although asymptomatic, the evaluation of prognostically significant myocardial ischemia should be considered in these high-risk patients. Eventually, a clinical trial is needed to address whether carotid patients would benefit from early intervention.
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Nuotio et al. (2015) conducted a cohort in Stenosing Carotid Artery Disease (n=801). Prior carotid endarterectomy vs. Population controls was evaluated on Acute myocardial infarction (HR 4.4, p=0.002). Patients with prior carotid endarterectomy had a 4.4-fold higher risk of acute myocardial infarction compared with population controls (P=0.002).
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