Division of Cardiology, Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, RI (F.V.L., J.D.A., P.A.S., H.D.A.).
Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.K.).
Circ Cardiovasc Interv. 2020 Apr;13(4):e008508. doi: 10.1161/CIRCINTERVENTIONS.119.008508. Epub 2020 Mar 26.
Contemporary, nationally representative 30-day readmissions data after carotid artery stenting (CAS) and carotid endarterectomy (CEA) are lacking.
Patients undergoing CAS or CEA were identified from the 2013 to 2014 Nationwide Readmissions Databases. Propensity matching was used to balance baseline clinical characteristics. Thirty-day nonelective readmission rates, length of stay, and causes of readmission were compared.
Overall, 85 337 (national estimate of 194 332) patients were identified before propensity score matching, 11 490 (13.4%) of whom underwent CAS and 73 847 (86.6%) of whom underwent CEA. Crude 30-day readmission rates were higher for patients treated with CAS than CEA (8.3% versus 6.8%; <0.001), but these differences were negated in the propensity-matched cohort (n=22 214; 8.4% versus 7.9%, =0.20), and readmission length of stay was longer for CEA than CAS (2 versus 1 day, respectively; =0.002). The most common reasons for readmission were neurological and cardiac events; readmission reasons varied by revascularization modality. Readmission due to a stroke or transient ischemic attack was more common among patients treated with CAS than CEA (1.2% versus 0.9%; =0.042), while readmission for procedural or medical complications occurred more often following CEA than CAS (1.1% versus 0.5%; <0.001); readmission rates for cardiac causes were similar between groups.
Less than 8% of patients are readmitted within 30 days of a carotid revascularization procedure. After adjusting for baseline differences, readmission rates are similar for CAS and CEA although readmission length of stay is longer after the latter. Readmission for neurological causes was more common following CAS while readmission for procedural or medical complications occurred more often following CEA. Higher annual institutional CEA volumes were associated with lower risk for 30-day readmission; in contrast, institutional CAS volumes were not related to readmission risk. These data provide important insights into the short-term, outcomes of patients following carotid artery revascularization.
目前缺乏颈动脉支架置入术（CAS）和颈动脉内膜切除术（CEA）后 30 天再入院的全国代表性数据。
从 2013 年至 2014 年全国再入院数据库中确定接受 CAS 或 CEA 的患者。采用倾向评分匹配来平衡基线临床特征。比较 30 天非选择性再入院率、住院时间和再入院原因。
总体而言，在倾向评分匹配前共确定了 85337 例（全国估计为 194332 例）患者，其中 11490 例（13.4%）接受了 CAS，73847 例（86.6%）接受了 CEA。CAS 治疗患者的 30 天再入院率高于 CEA（8.3%比 6.8%；<0.001），但在倾向匹配队列中差异被消除（n=22214；8.4%比 7.9%，=0.20），CEA 的再入院住院时间长于 CAS（分别为 2 天和 1 天；=0.002）。最常见的再入院原因是神经和心脏事件；再入院原因因血运重建方式而异。CAS 治疗患者因中风或短暂性脑缺血发作而再次入院的比例高于 CEA（1.2%比 0.9%；=0.042），而 CEA 比 CAS 更常见因手术或医疗并发症再次入院（1.1%比 0.5%；<0.001）；两组心脏原因的再入院率相似。
不到 8%的患者在颈动脉血运重建术后 30 天内再次入院。在调整基线差异后，CAS 和 CEA 的再入院率相似，尽管后者的再入院住院时间较长。CAS 治疗后神经原因的再入院更为常见，而 CEA 后更常因手术或医疗并发症再次入院。更高的年度机构 CEA 量与 30 天内再入院风险降低相关；相反，机构 CAS 量与再入院风险无关。这些数据提供了有关颈动脉血运重建后患者短期结局的重要见解。
