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Impact of Chronic Renal Insufficiency on the Early and Late Clinical Outcomes of Carotid Artery Stenting Using Serum Creatinine vs Glomerular Filtration Rate
- Source :
- Journal of the American College of Surgeons. 218:797-805
- Publication Year :
- 2014
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2014.
-
Abstract
- This study analyzed the impact of chronic renal insufficiency (CRI) on early and late clinical outcomes of carotid artery stenting (CAS) using serum creatinine and glomerular filtration rate (GFR).There were 313 CAS patients classified into 3 groups: normal (serum creatinine1.5 mg/dL or GFR ≥ 60 mL/min/1.73 m(2)); moderate CRI, and severe CRI (serum creatinine ≥ 3 or GFR30 mL/min/1.73 m(2)). Major adverse events ([MAE] stroke, death, and myocardial infarction) were compared for all groups.Using serum creatinine, perioperative stroke rates for normal, moderate, and severe CRI were: 5%, 0%, and 25%, respectively, (p = 0.05) vs 4.6%, 3.7%, and 11.1%, respectively, (p = 0.44) using GFR. The perioperative MAE rates for symptomatic patients were 9.3% and 0% (p = 0.355) and 2% and 5.9% (p = 0.223) for asymptomatic patients for normal and moderate/severe CRI, respectively, using serum creatinine vs 8.1% and 7.8%, respectively, for symptomatic patients and 2.5% and 3%, respectively, for asymptomatic patients using GFR. At a mean follow-up of 21 months, late MAE rates in normal vs moderate/severe CRI patients were 8.2% and 14%, respectively, (p = 0.247) using serum creatinine vs 6.6% and 13.3%, respectively, (p = 0.05) using GFR. Late MAE rates for symptomatic patients in normal vs moderate/severe CRI were: 8.7% vs 27%, respectively, (p = 0.061) using serum creatinine and 5.7% vs 18.8%, respectively, (p = 0.026) using GFR. Late death rate was 0.55% in normal vs 7.6% (p = 0.002) for moderate/severe CRI. Freedom from MAE at 3 years in symptomatic patients was 81% in normal and 46% in moderate/severe CRI (p = 0.0198). A multivariate Cox regression analysis showed that a GFR of60 mL/min/1.73 m(2) had an odds ratio of 1.6 (p = 0.222) of having a MAE after CAS.The GFR was more sensitive in detecting late MAE after CAS. Carotid artery stenting in moderate CRI patients can be done with a satisfactory perioperative outcome; however, late death was significant.
- Subjects :
- Adult
medicine.medical_specialty
medicine.medical_treatment
Myocardial Infarction
Urology
Renal function
Kaplan-Meier Estimate
Carotid endarterectomy
Sensitivity and Specificity
Severity of Illness Index
Asymptomatic
chemistry.chemical_compound
Postoperative Complications
Risk Factors
Severity of illness
Odds Ratio
Humans
Medicine
Carotid Stenosis
Myocardial infarction
Renal Insufficiency, Chronic
Stroke
Aged
Proportional Hazards Models
Retrospective Studies
Aged, 80 and over
Creatinine
business.industry
Perioperative
Middle Aged
medicine.disease
Surgery
Logistic Models
Treatment Outcome
chemistry
Stents
medicine.symptom
business
Biomarkers
Follow-Up Studies
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 10727515
- Volume :
- 218
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Surgeons
- Accession number :
- edsair.doi.dedup.....8d854cba720bbc05f74d0924a1cc8e34