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The impact of Centers for Medicare and Medicaid Services high-risk criteria on outcome after carotid endarterectomy and carotid artery stenting in the SVS Vascular Registry
- Source :
- Journal of Vascular Surgery. (5):1318-1324
- Publisher :
- Society for Vascular Surgery. Published by Elsevier Inc.
-
Abstract
- ObjectiveThe Centers for Medicare and Medicaid Services (CMS) require high-risk (HR) criteria for carotid artery stenting (CAS) reimbursement. The impact of these criteria on outcomes after carotid endarterectomy (CEA) and CAS remains uncertain. Additionally, if these HR criteria are associated with more adverse events after CAS, then existing comparative effectiveness analysis of CEA vs CAS may be biased. We sought to elucidate this using data from the SVS Vascular Registry.MethodsWe analyzed 10,107 patients undergoing CEA (6370) and CAS (3737), stratified by CMS HR criteria. The primary endpoint was composite death, stroke, and myocardial infarction (MI) (major adverse cardiovascular event [MACE]) at 30 days. We compared baseline characteristics and outcomes using univariate and multivariable analyses.ResultsCAS patients were more likely to have preoperative stroke (26% vs 21%) or transient ischemic attack (23% vs 19%) than CEA. Although age ≥80 years was similar, CAS patients were more likely to have all other HR criteria. For CEA, HR patients had higher MACEs than normal risk in both symptomatic (7.3% vs 4.6%; P < .01) and asymptomatic patients (5% vs 2.2%; P < .0001). For CAS, HR status was not associated with a significant increase in MACE for symptomatic (9.1% vs 6.2%; P = .24) or asymptomatic patients (5.4% vs 4.2%; P = .61). All CAS patients had MACE rates similar to HR CEA. After multivariable risk adjustment, CAS had higher rates than CEA for MACE (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0-1.5), death (OR, 1.5; 95% CI, 1.0-2.2), and stroke (OR, 1.3; 95% CI,1.0-1.7), whereas there was no difference in MI (OR, 0.8; 95% CI, 0.6-1.3). Among CEA patients, age ≥80 (OR, 1.4; 95% CI, 1.02-1.8), congestive heart failure (OR, 1.7; 95% CI, 1.03-2.8), EF
- Subjects :
- Adult
Carotid Artery Diseases
Male
medicine.medical_specialty
Time Factors
Adolescent
medicine.medical_treatment
Myocardial Infarction
Carotid endarterectomy
Asymptomatic
Risk Assessment
Article
Centers for Medicare and Medicaid Services, U.S
Decision Support Techniques
Young Adult
Risk Factors
Internal medicine
Angioplasty
medicine
Odds Ratio
Humans
Myocardial infarction
Registries
Stroke
Endarterectomy
Aged
Aged, 80 and over
Endarterectomy, Carotid
Chi-Square Distribution
business.industry
Patient Selection
Odds ratio
Middle Aged
medicine.disease
United States
Surgery
Treatment Outcome
Ischemic Attack, Transient
Multivariate Analysis
Cardiology
Female
Stents
medicine.symptom
business
Cardiology and Cardiovascular Medicine
Mace
Subjects
Details
- Language :
- English
- ISSN :
- 07415214
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Journal of Vascular Surgery
- Accession number :
- edsair.doi.dedup.....94d95bfe719234388c6548baa27e4bba
- Full Text :
- https://doi.org/10.1016/j.jvs.2012.10.107