Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA.
J Vasc Surg. 2012 Jan;55(1):72-8. doi: 10.1016/j.jvs.2011.08.007. Epub 2011 Nov 8.
Data derived from prospective randomized clinical trials suggest differential comparative benefit between carotid angioplasty and stent (CAS) placement and carotid endarterectomy (CEA) in various age strata. We sought to investigate the impact of age on outcomes of CAS and CEA in general practice.
We analyzed the data from the Nationwide Inpatient Sample (NIS), which is representative of all admissions in the United States from 2005 to 2008. The primary end point was occurrence of stroke, cardiac complications, or death during the postprocedural period. Outcomes of interest were compared between patients aged ≥70 years and <70 years, undergoing CEA and CAS. Multivariate logistic regression was performed to determine the effect of age on occurrence of postoperative stroke, cardiac complications, or death. Covariates included in the logistic regression were patient's age, gender, comorbid conditions, including hypertension, diabetes mellitus (DM), chronic lung disease, coronary artery disease (CAD), congestive heart failure (CHF), and renal failure; symptom status (symptomatic vs asymptomatic status), and hospital characteristics.
Of the total 495,331 estimated patients who received treatment for CAD during the study period, 88% underwent CEA and the remaining 12% underwent CAS. Of the total procedures, 41% of the procedures were performed in patients aged <70 years compared to the remaining 59% that were performed among patients aged ≥70 years. For patients undergoing CAS, age ≥70 years was an important predictor of postoperative stroke (P = .0025; odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.5) and cardiac complications postprocedure (P = .045; OR, 1.3; 95% CI, 1.0-1.6). For patients undergoing CEA, age ≥70 years was associated with higher cardiac complications (P < .001; OR, 1.5; 95% CI, 1.3-1.7) and higher postoperative mortality risk (P = .0008; OR, 1.4; 95% CI, 1.1-1.8) compared to patients aged <70 years. The increased risk of composite end point (postoperative stroke/cardiac complications/mortality) among patients aged ≥70 years was a significant factor for patients undergoing either CAS or CEA (OR of 1.3 for both procedures).
Our analysis suggests that most CAS and CEAs are performed in patients aged ≥70 years in general practice, and higher rates of postoperative complications are observed among these patients regardless of procedure choice.
前瞻性随机临床试验得出的数据表明，在不同年龄层，颈动脉血管成形术和支架置入术（CAS）与颈动脉内膜切除术（CEA）之间存在差异比较优势。我们旨在研究年龄对普通实践中 CAS 和 CEA 结果的影响。
我们分析了 2005 年至 2008 年全美住院患者样本（NIS）的数据，该样本代表了美国所有的住院患者。主要终点是术后期间发生中风、心脏并发症或死亡。比较了年龄≥70 岁和<70 岁患者接受 CEA 和 CAS 的结果。多变量逻辑回归用于确定年龄对术后中风、心脏并发症或死亡发生的影响。逻辑回归中包含的协变量包括患者的年龄、性别、合并症，包括高血压、糖尿病（DM）、慢性肺病、冠状动脉疾病（CAD）、充血性心力衰竭（CHF）和肾衰竭；症状状态（有症状与无症状状态）和医院特征。
在研究期间接受 CAD 治疗的总计 495331 名估计患者中，88%接受了 CEA，其余 12%接受了 CAS。在所有手术中，41%的手术是在年龄<70 岁的患者中进行的，而其余 59%的手术是在年龄≥70 岁的患者中进行的。对于接受 CAS 的患者，年龄≥70 岁是术后中风的重要预测因素（P =.0025；优势比[OR]，1.7；95%置信区间[CI]，1.2-2.5）和术后心脏并发症（P =.045；OR，1.3；95%CI，1.0-1.6）。对于接受 CEA 的患者，年龄≥70 岁与更高的心脏并发症（P <.001；OR，1.5；95%CI，1.3-1.7）和更高的术后死亡率风险（P =.0008；OR，1.4；95%CI，1.1-1.8）相关，与年龄<70 岁的患者相比。年龄≥70 岁的患者发生复合终点（术后中风/心脏并发症/死亡率）的风险增加是接受 CAS 或 CEA 治疗的患者的一个重要因素（两种手术的 OR 均为 1.3）。
我们的分析表明，在普通实践中，大多数 CAS 和 CEA 是在年龄≥70 岁的患者中进行的，无论选择哪种手术，这些患者术后并发症发生率更高。
