Department of Surgery, University of Wisconsin Hospital & Clinics, Madison, WI, USA.
J Vasc Surg. 2013 Feb;57(2):318-26. doi: 10.1016/j.jvs.2012.08.116. Epub 2012 Nov 15.
The latest guidelines recommend performance of carotid endarterectomy (CEA) on asymptomatic patients with high-grade carotid stenosis, only if the combined perioperative stroke, myocardial infarction (MI), or death risk is ≤3%. Our objective was to develop and validate a risk index to estimate the combined risk of perioperative stroke, MI, or death in asymptomatic patients undergoing elective CEA.
Asymptomatic patients who underwent an elective CEA (n = 17,692) were identified from the 2005-2010 National Surgical Quality Improvement Program, a multicenter, prospective database. Multivariable logistic regression analysis was performed with primary outcome of interest being the composite of any stroke, MI, or death during the 30-day periprocedural period. Bootstrapping was used for internal validation. A risk index was created by assigning weighted points to each predictor using the β-coefficients from the regression analysis.
Fifty-eight percent of the patients were men with a median age of 72 years. Thirty-day incidences of stroke, MI, and death were 0.9% (n = 167), 0.6% (n = 108), and 0.4% (n = 72), respectively. The combined 30-day stroke, MI, or death incidence was 1.8% (n = 324). On multivariable analysis, six independent predictors were identified and a risk index created by assigning weighted points to each predictor using the β-coefficients from the regression analysis. The predictors included age in years (<60: 0 point; 60-69: -1 point; 70-79: -1 point; ≥80: 2 points), dyspnea (2 points), chronic obstructive pulmonary disease (3 points), previous peripheral revascularization or amputation (3 points), recent angina within 1 month (4 points), and dependent functional status (5 points). Patients were classified as low (<3%), intermediate (3%-6%), or high (>6%) risk for combined 30-day stroke, MI, or death, based on a total point score of <4, 4-7, and >7, respectively. There were 15,249 patients (86.2%) in the low-risk category, 2233 (12.6%) in the intermediate-risk category, and 210 (1.2%) in the high-risk category.
The validated risk index can help identify asymptomatic patients who are at greatest risk for 30-day stroke, MI, and death after CEA, thereby aiding patient selection.
最新指南建议对有重度颈动脉狭窄的无症状患者进行颈动脉内膜切除术（CEA），但需满足围手术期卒中、心肌梗死（MI）或死亡联合风险≤3%。我们的目的是开发和验证一种风险指数，以估计择期 CEA 无症状患者围手术期卒中、MI 或死亡的联合风险。
从 2005-2010 年国家手术质量改进计划的多中心前瞻性数据库中确定了 17692 例接受择期 CEA 的无症状患者。主要观察结果为 30 天围手术期内任何卒中、MI 或死亡的复合结果。使用内部验证的 bootstrap 方法进行多变量逻辑回归分析。通过使用回归分析中的β系数为每个预测因子分配加权分数，创建风险指数。
58%的患者为男性，中位年龄为 72 岁。30 天卒中、MI 和死亡的发生率分别为 0.9%（n=167）、0.6%（n=108）和 0.4%（n=72）。联合 30 天卒中、MI 或死亡发生率为 1.8%（n=324）。多变量分析确定了 6 个独立的预测因子，并通过使用回归分析中的β系数为每个预测因子分配加权分数，创建风险指数。预测因子包括年龄（<60 岁：0 分；60-69 岁：-1 分；70-79 岁：-1 分；≥80 岁：2 分）、呼吸困难（2 分）、慢性阻塞性肺疾病（3 分）、既往外周血管重建或截肢（3 分）、1 个月内近期心绞痛（4 分）和依赖的功能状态（5 分）。根据总分<4、4-7 和>7，将患者分为低（<3%）、中（3%-6%）或高（>6%）风险的 30 天卒中、MI 或死亡联合风险。低风险组有 15249 例（86.2%），中风险组有 2233 例（12.6%），高风险组有 210 例（1.2%）。
验证后的风险指数可以帮助识别 CEA 后 30 天卒中、MI 和死亡风险最高的无症状患者，从而辅助患者选择。
