TY - JOUR
T1 - Society for Vascular Surgery (SVS) Vascular Registry evaluation of comparative effectiveness of carotid revascularization procedures stratified by Medicare age
AU - Jim, Jeffrey
AU - Rubin, Brian G.
AU - Ricotta, Joseph J.
AU - Kenwood, Christopher T.
AU - Siami, Flora S.
AU - Sicard, Gregorio A.
PY - 2012/5
Y1 - 2012/5
N2 - Objective: Recent randomized controlled trials have shown that age significantly affects the outcome of carotid revascularization procedures. This study used data from the Society for Vascular Surgery Vascular Registry (VR) to report the influence of age on the comparative effectiveness of carotid endarterectomy (CEA) and carotid artery stenting (CAS). Methods: VR collects provider-reported data on patients using a Web-based database. Patients were stratified by age and symptoms. The primary end point was the composite outcome of death, stroke, or myocardial infarction (MI) at 30 days. Results: As of December 7, 2010, there were 1347 CEA and 861 CAS patients aged <65 years and 4169 CEA and 2536 CAS patients aged <65 years. CAS patients in both age groups were more likely to have a disease etiology of radiation or restenosis, be symptomatic, and have more cardiac comorbidities. In patients aged <65 years, the primary end point (5.23% CAS vs 3.56% CEA; P =.065) did not reach statistical significance. Subgroup analyses showed that CAS had a higher combined death/stroke/MI rate (4.44% vs 2.10%; P <.031) in asymptomatic patients but there was no difference in the symptomatic (6.00% vs 5.47%; P =.79) group. In patients aged <65 years, CEA had lower rates of death (0.91% vs 1.97%; P <.01), stroke (2.52% vs 4.89%; P <.01), and composite death/stroke/MI (4.27% vs 7.14%; P <.01). CEA in patients aged <65 years was associated with lower rates of the primary end point in symptomatic (5.27% vs 9.52%; P <.01) and asymptomatic (3.31% vs 5.27%; P <.01) subgroups. After risk adjustment, CAS patients aged <65 years were more likely to reach the primary end point. Conclusions: Compared with CEA, CAS resulted in inferior 30-day outcomes in symptomatic and asymptomatic patients aged <65 years. These findings do not support the widespread use of CAS in patients aged <65 years.
AB - Objective: Recent randomized controlled trials have shown that age significantly affects the outcome of carotid revascularization procedures. This study used data from the Society for Vascular Surgery Vascular Registry (VR) to report the influence of age on the comparative effectiveness of carotid endarterectomy (CEA) and carotid artery stenting (CAS). Methods: VR collects provider-reported data on patients using a Web-based database. Patients were stratified by age and symptoms. The primary end point was the composite outcome of death, stroke, or myocardial infarction (MI) at 30 days. Results: As of December 7, 2010, there were 1347 CEA and 861 CAS patients aged <65 years and 4169 CEA and 2536 CAS patients aged <65 years. CAS patients in both age groups were more likely to have a disease etiology of radiation or restenosis, be symptomatic, and have more cardiac comorbidities. In patients aged <65 years, the primary end point (5.23% CAS vs 3.56% CEA; P =.065) did not reach statistical significance. Subgroup analyses showed that CAS had a higher combined death/stroke/MI rate (4.44% vs 2.10%; P <.031) in asymptomatic patients but there was no difference in the symptomatic (6.00% vs 5.47%; P =.79) group. In patients aged <65 years, CEA had lower rates of death (0.91% vs 1.97%; P <.01), stroke (2.52% vs 4.89%; P <.01), and composite death/stroke/MI (4.27% vs 7.14%; P <.01). CEA in patients aged <65 years was associated with lower rates of the primary end point in symptomatic (5.27% vs 9.52%; P <.01) and asymptomatic (3.31% vs 5.27%; P <.01) subgroups. After risk adjustment, CAS patients aged <65 years were more likely to reach the primary end point. Conclusions: Compared with CEA, CAS resulted in inferior 30-day outcomes in symptomatic and asymptomatic patients aged <65 years. These findings do not support the widespread use of CAS in patients aged <65 years.
UR - http://www.scopus.com/inward/record.url?scp=84860386582&partnerID=8YFLogxK
U2 - 10.1016/j.jvs.2011.11.128
DO - 10.1016/j.jvs.2011.11.128
M3 - Article
C2 - 22459755
AN - SCOPUS:84860386582
SN - 0741-5214
VL - 55
SP - 1313
EP - 1321
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 5
ER -