School of Medicine, Zhejiang University , Hangzhou, Zhejiang Province, China.
Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University , Hangzhou, China.
Postgrad Med. 2020 Nov;132(8):756-763. doi: 10.1080/00325481.2020.1768765. Epub 2020 May 20.
: We study whether the carotid artery stenting (CAS) and carotid endarterectomy (CEA) differ from each other in postoperative ventricular arrhythmia, along with neurological complications (perioperative stroke and transient ischemic attack), in-hospital mortality, and estimated medical cost. : This study used data of patients with carotid artery stenosis from the National Inpatient Sample (NIS) database (2011-2014) from the United States of America. Based on the procedure that patients received, individuals were categorized into groups of CAS and CEA. Multilevel analyses were conducted to examine the difference in the following outcomes: postoperative ventricular arrhythmia, neurological complications, in-hospital mortality, and medical costs between CAS and CEA. The patient age, gender, race, Charlson Comorbidity Index, primary payer, emergency department service record, bed size of hospital, region of the hospital, and location of the hospital were adjusted in each model. In addition, preexisting cardiovascular diseases (CVDs) were adjusted for when predicting postoperative ventricular arrhythmia; postoperative CVDs were adjusted for in the model of in-hospital mortality. : A total of 127,321 carotid artery stenosis hospitalizations were included in our analyses ( = 17,074 in CAS, = 110,247 in CEA). Multivariate logistic regressions showed that compared with patients underwent CAS, those with CEA had a lower odds of postoperative ventricular arrhythmia (odds ratio [OR] = 0.81, 95% confidence interval [CI]: [0.66-0.98]), less neurological complications (OR = 0.55, 95% CI: [0.51-0.59] in general; OR = 0.63, 95% CI: [0.57-0.69] in ischemic stroke; OR = 0.26, 95% CI: [0.20-0.32] in hemorrhagic stroke; and OR = 0.58, 95% CI: [0.47-0.71] in transient ischemic attack), and in-hospital mortality (OR = 0.52, 95% CI: [0.42-0.64]). Generalized linear model indicated patients undergoing CEA had lower medical cost (β = -4329.99, 95% CI: [-4552.61, -4107.38]) than patients undergoing CAS. : In short-term outcomes, CEA was associated with a lower risk of postoperative ventricular arrhythmia, neurological complications, in-hospital mortality, and lower cost as compared with CAS.
我们研究颈动脉支架置入术（CAS）和颈动脉内膜切除术（CEA）在术后室性心律失常、神经并发症（围手术期卒中和短暂性脑缺血发作）、住院死亡率和估计医疗费用方面是否存在差异。
这项研究使用了美国国家住院患者样本（NIS）数据库（2011-2014 年）中颈动脉狭窄患者的数据。根据患者接受的治疗方法，将患者分为 CAS 和 CEA 组。采用多水平分析方法比较 CAS 和 CEA 之间术后室性心律失常、神经并发症、住院死亡率和医疗费用的差异。在每个模型中，调整了患者的年龄、性别、种族、Charlson 合并症指数、主要支付方、急诊部门服务记录、医院病床大小、医院所在地区和医院位置。此外，在预测术后室性心律失常时，调整了预先存在的心血管疾病（CVDs）；在住院死亡率模型中，调整了术后 CVDs。
我们的分析共纳入了 127321 例颈动脉狭窄住院患者（CAS 组 17074 例，CEA 组 110247 例）。多变量逻辑回归显示，与接受 CAS 的患者相比，接受 CEA 的患者术后室性心律失常的可能性较低（比值比[OR]为 0.81，95%置信区间[CI]：[0.66-0.98]），神经并发症较少（OR 为 0.55，95%CI：[0.51-0.59]一般情况下；OR 为 0.63，95%CI：[0.57-0.69]缺血性卒中；OR 为 0.26，95%CI：[0.20-0.32]出血性卒中；OR 为 0.58，95%CI：[0.47-0.71]短暂性脑缺血发作）和住院死亡率（OR 为 0.52，95%CI：[0.42-0.64]）。广义线性模型表明，与接受 CAS 的患者相比，接受 CEA 的患者的医疗费用较低（β=-4329.99，95%CI：[-4552.61，-4107.38]）。
总之，与 CAS 相比，CEA 与术后室性心律失常、神经并发症、住院死亡率较低以及成本较低相关。
