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Contralateral carotid stenosis is a predictor of long-term adverse events in carotid endarterectomy

2022Journal article Restricted
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dc.contributor.authorMoreira, Rita
dc.contributor.authorDuarte-Gamas, Luís
dc.contributor.authorPereira-Macedo, Juliana
dc.contributor.authorPereira-Neves, António
dc.contributor.authorDomingues-Monteiro, Diogo
dc.contributor.authorJácome, Filipa
dc.contributor.authorAndrade, José P.
dc.contributor.authorMarreiros, Ana
dc.contributor.authorRocha-Neves, João
dc.date.accessioned2022-05-09T14:33:36Z
dc.date.available2022-05-09T14:33:36Z
dc.date.issued2022
dc.description.abstractContralateral carotid stenosis (cICS) has been described as a perioperative predictor of mortality after carotid endarterectomy (CEA). However, its predictive value on long-term cardiovascular events remains controversial. The study aims to assess the potential role of cICS as a long-term predictor of major adverse cardiovascular events (MACE) in patients who underwent CEA. From January 2012 to July 2020, patients undergoing CEA under regional anesthesia for carotid stenosis in a tertiary care and referral center were eligible from a prospective database, and a post hoc analysis was performed. The primary outcome consisted in the occurrence of long-term MACE. Secondary outcomes included all-cause mortality, stroke, myocardial infarction, acute heart failure, and major adverse limb events. A total of 192 patients were enrolled. With a median 50 months follow-up, chronic kidney disease (CKD) (mean survival time (MST) 51.7 vs. 103.3, P < 0.010) and peripheral artery disease (PAD) (MST 75.1 vs. 90.3, P = 0.001) were associated with decreased survival time. After propensity score matching (PSM), CKD (MST 49.1 vs. 106.0, P = 0.001) and PAD (MST 75.7 vs. 94.0, P = 0.001) maintained this association. On multivariate Cox regression analysis, contralateral stenosis was associated with higher MACE (hazard ratio (HR) = 2.035; 95% CI: 1.113-3.722, P = 0.021 and all-cause mortality (HR = 2.564; 95% CI: 1.276-5,152 P = 0.008). After PSM, only all-cause mortality (HR 2.323; 95% CI: 0.993-5.431, P = 0.052) maintained a significant association with cICS. On multivariable analysis, cICS (aHR 2.367; 95% CI: 1.174-4.771, P = 0.016), age (aHR 1.039, 95% CI: 1.008-1.070), CKD (aHR 2.803; 95% CI: 1.409-5.575, P = 0.003) and PAD (aHR 3.225, 95% CI: 1.695-6.137, P < 0.001) were independently associated with increased all-cause mortality. Contrary to MACE, cICS is a strong predictor of long-term all-cause mortality after CEA. However, MACE risk may compromise CEA benefits by other competitive events. Therefore, further studies are needed to establish the role of cICS on postoperative events and on patients' specific assessments in order to determine the best medical treatment and easy access to surgical intervention.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.doi10.1016/j.avsg.2021.07.017pt_PT
dc.identifier.issn0890-5096
dc.identifier.urihttp://hdl.handle.net/10400.1/17804
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectCarotid endarterectomypt_PT
dc.subjectCarotid stenosispt_PT
dc.subjectMACEpt_PT
dc.subjectSurvival analysispt_PT
dc.subjectPrognosispt_PT
dc.subjectMajor Cardiovascular Eventspt_PT
dc.subjectMortalitypt_PT
dc.titleContralateral carotid stenosis is a predictor of long-term adverse events in carotid endarterectomypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage255pt_PT
oaire.citation.startPage247pt_PT
oaire.citation.titleAnnals of Vascular Surgerypt_PT
oaire.citation.volume79pt_PT
person.familyNameMoreira
person.familyNameMarreiros
person.givenNameRita
person.givenNameAna
person.identifier.ciencia-id9A12-9450-7051
person.identifier.orcid0000-0002-8162-1719
person.identifier.orcid0000-0001-9410-4772
person.identifier.scopus-author-id57194785077
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication45bf6166-a7ab-4139-864e-c172e33505d6
relation.isAuthorOfPublicationc0a8e5da-26ae-42a8-ab04-fa4df4356375
relation.isAuthorOfPublication.latestForDiscoveryc0a8e5da-26ae-42a8-ab04-fa4df4356375

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