Polyvascular disease in patients undergoing carotid endarterectomy was associated with an increased risk of long-term MACE (aHR 2.531; 95% CI 1.439-4.450; P<0.001) and all-cause mortality.
Cohort (n=207)
No
Does polyvascular disease predict long-term MACE and all-cause mortality in patients undergoing carotid endarterectomy?
Polyvascular disease is a strong independent predictor of long-term MACE and all-cause mortality in patients undergoing carotid endarterectomy.
Effect estimate: aHR 2.531 (95% CI 1.439-4.450)
p-value: p=<0.001
INTRODUCTION/OBJECTIVE: Carotid stenosis (CS) is an important cause of ischemic stroke. Secondary prevention lies in performing a carotid endarterectomy (CEA) procedure, the recommended treatment in most cases. When 2 or more vascular regions are simultaneously affected by atherosclerosis, mainly the carotid arteries, coronary arteries, or limb arteries, a multivessel disease polyvascular disease (PVD) is present. This study aims to assess the potential role of PVD as a long-term predictor of major adverse cardiovascular events (MACE) and all-cause mortality in patients submitted to CEA. METHODS: From January 2012 to December 2021, patients submitted to CEA for carotid stenosis in a tertiary care and referral center were eligible from a prospective database. A posthoc survival analysis was performed using the Kaplan-Meier survival curve method. The primary outcome was the incidence of long-term MACE and all-cause mortality. Secondary outcomes included acute myocardial infarction (AMI), major adverse limb events (MALE), stroke, and acute heart failure (AHF). RESULTS: A total of 207 patients were enrolled, with a median follow-up of 63 months. The mean age was 70.4 ± 8.9, and 163 (78.7%) were male. There were 65 (31.4%) patients that had 2 arterial vascular territories affected, and 29 (14.0%) patients had PVD in 3 arterial beds. On multivariable analysis, both MACE and all-cause mortality had as independent risk factors age (aHR 1.039, P = 0.003; aHR 1.041, P = 0.019), chronic kidney disease (aHR 2.524, P = 0.003; aHR 3.377, P < 0.001) and PVD2 (aHR 3.381, P < 0.001; aHR 2.665, P = 0.013). PVD1 was only associated with MACE as a statistically significant risk factor (aHR 2.531, 1.439-4.450, P < 0.001). CONCLUSIONS: PVD in patients with cerebrovascular disease (CVD) was revealed to carry a 2-fold increased risk for all-cause mortality and MACE during long-term follow-up. PVD may be a simple yet valuable tool in predicting all-cause mortality, MACE, AMI, and MALE after CEA.
Thierstein et al. (Tue,) conducted a cohort in Carotid stenosis (n=207). Polyvascular disease (PVD) vs. No polyvascular disease was evaluated on Incidence of long-term MACE and all-cause mortality (aHR 2.531, 95% CI 1.439-4.450, p=<0.001). Polyvascular disease in patients undergoing carotid endarterectomy was associated with an increased risk of long-term MACE (aHR 2.531; 95% CI 1.439-4.450; P<0.001) and all-cause mortality.