Pre-procedural Risk Quantification for Carotid Stenting Using the CAS Score A Report From the NCDR CARE Registry

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:60

Article

Hawkins, Beau M.¹  Kennedy, Kevin F.²  Giri, Jay¹  Saltzman, Adam J.¹  Rosenfield, Kenneth¹  Drachman, Douglas E.¹  White, Christopher J.³  Spertus, John A.²  Yeh, Robert W.¹ 

[1] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Div Cardiol, Boston, MA 02114 USA

[2] Univ Missouri, St Lukes Mid Amer Heart Inst, Kansas City, MO 64110 USA

[3] Ochsner Med Ctr, John Ochsner Heart & Vasc Inst, New Orleans, LA USA

关键词: carotid stenosis;    carotid stenting;    risk score;   

DOI  :  10.1016/j.jacc.2012.07.026

来源: Elsevier

【 摘 要 】

Objectives We developed and internally validated a risk score to predict in-hospital stroke or death after carotid artery stenting (CAS). Background A tool that accurately assesses CAS risk could aid clinical decision making and improve patient selection. Methods Patients undergoing CAS without acute evolving stroke from April 2005 through June 2011 as part of the NCDR Carotid Artery Revascularization and Endarterectomy (CARE) Registry were included. In-hospital stroke or death was modeled using logistic regression with 35 candidate variables. Internal validation was achieved with boot-strapping, and model discrimination and calibration were assessed. Results A total of 271 (2.4%) primary endpoint events occurred during 11,122 procedures. Independent predictors of stroke or death included impending major surgery, previous stroke, age, symptomatic lesion, atrial fibrillation, and absence of previous ipsilateral carotid endarterectomy. The model was well calibrated with moderate discriminatory ability (C-statistic: 0.71) overall, and within symptomatic (C-statistic: 0.68) and asymptomatic (C-statistic: 0.72) subgroups. The inclusion of available angiographic variables did not improve model performance (C-statistic: 0.72, integrated discrimination improvement 0.001; p = 0.21). The NCDR CAS score was developed to support prospective risk quantification. Conclusions The NCDR CAS score, comprising 6 clinical variables, predicts in-hospital S/D after CAS. This tool may be useful to assist clinicians in evaluating optimal management, share more accurate pre-procedural risks with patients, and improve patient selection for CAS. (J Am Coll Cardiol 2012;60:1617-22) (c) 2012 by the American College of Cardiology Foundation

【 授权许可】

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