TY - JOUR
T1 - Late outcomes after carotid artery stenting versus carotid endarterectomy
T2 - Insights from a propensity-matched analysis of the reduction of atherothrombosis for continued health (REACH) registry
AU - Bangalore, Sripal
AU - Bhatt, Deepak L.
AU - Röther, Joachim
AU - Alberts, Mark J.
AU - Thornton, Julie
AU - Wolski, Kathy
AU - Goto, Shinya
AU - Hirsch, Alan T.
AU - Smith, Sidney C.
AU - Aichner, Franz T.
AU - Topakian, Raffi
AU - Cannon, Christopher P.
AU - Steg, P. Gabriel
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/9/14
Y1 - 2010/9/14
N2 - Background-: In patients with carotid artery disease, carotid endarterectomy (CEA) and carotid stenting (CAS) are treatment options. Controversy exists as to the relative efficacy of the 2 techniques in preventing late events. Methods and Results-: The Reduction of Atherothrombosis for Continued Health (REACH) Registry recruited >68 000 outpatients ≥45 years of age with established atherothrombotic disease or ≥3 risk factors for atherothrombosis. Patients with CAS or CEA were chosen and followed up prospectively for the occurrence of cardiovascular events. Propensity score matching was performed to assemble a cohort of patients in whom all baseline covariates would be well balanced. Primary outcome was defined as death or stroke at the 2-year follow-up. Secondary outcome was stroke or transient ischemic attack. Tertiary outcome was a composite of death, myocardial infarction, or stroke and the individual outcomes. Of the 68 236 patients with atherothrombosis, 3412 patients (5%) had a history of carotid artery revascularization (70% asymptomatic carotid stenosis), 1025 (30%) with CAS and 2387 (70%) with CEA. Propensity score analyses matched 836 CAS patients with 836 CEA patients. At the end of 2 years of follow-up, in the propensity score-matched cohort, CAS was associated with a risk similar to CEA for the primary (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.57 to 1.26), secondary (HR, 1.20; 95% CI, 0.73 to 1.96), and tertiary (HR, 0.72; 95% CI, 0.51 to 1.01) composite outcome, death (HR, 0.63; 95% CI, 0.40 to 1.00), and stroke (HR, 1.48; 95% CI, 0.79 to 2.80). CONCLUSION-: In a real-world cohort of patients with a history of carotid artery revascularization, CAS was comparable to CEA for late outcomes.
AB - Background-: In patients with carotid artery disease, carotid endarterectomy (CEA) and carotid stenting (CAS) are treatment options. Controversy exists as to the relative efficacy of the 2 techniques in preventing late events. Methods and Results-: The Reduction of Atherothrombosis for Continued Health (REACH) Registry recruited >68 000 outpatients ≥45 years of age with established atherothrombotic disease or ≥3 risk factors for atherothrombosis. Patients with CAS or CEA were chosen and followed up prospectively for the occurrence of cardiovascular events. Propensity score matching was performed to assemble a cohort of patients in whom all baseline covariates would be well balanced. Primary outcome was defined as death or stroke at the 2-year follow-up. Secondary outcome was stroke or transient ischemic attack. Tertiary outcome was a composite of death, myocardial infarction, or stroke and the individual outcomes. Of the 68 236 patients with atherothrombosis, 3412 patients (5%) had a history of carotid artery revascularization (70% asymptomatic carotid stenosis), 1025 (30%) with CAS and 2387 (70%) with CEA. Propensity score analyses matched 836 CAS patients with 836 CEA patients. At the end of 2 years of follow-up, in the propensity score-matched cohort, CAS was associated with a risk similar to CEA for the primary (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.57 to 1.26), secondary (HR, 1.20; 95% CI, 0.73 to 1.96), and tertiary (HR, 0.72; 95% CI, 0.51 to 1.01) composite outcome, death (HR, 0.63; 95% CI, 0.40 to 1.00), and stroke (HR, 1.48; 95% CI, 0.79 to 2.80). CONCLUSION-: In a real-world cohort of patients with a history of carotid artery revascularization, CAS was comparable to CEA for late outcomes.
KW - carotid arteries
KW - endarterectomy
KW - prognosis
KW - stents
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U2 - 10.1161/CIRCULATIONAHA.109.933341
DO - 10.1161/CIRCULATIONAHA.109.933341
M3 - Article
C2 - 20805431
AN - SCOPUS:77957269890
SN - 0009-7322
VL - 122
SP - 1091
EP - 1100
JO - Circulation
JF - Circulation
IS - 11
ER -