Development and validation of a score to predict life expectancy after carotid endarterectomy in asymptomatic patients

Michele Carmo, Iacopo Barbetta, Daniele Bissacco, Santi Trimarchi, Vincenzo Catanese, Matteo Bonzini, Stefano Bonardelli, Piergiorgio G. Settembrini

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Recent improvement of best medical treatment for carotid stenosis has sparked a debate on the role of surgery identification of patients who may benefit from carotid endarterectomy (CEA) is crucial to avoid overtreatment. An expected 5-year postoperative survival is one of the main selection criteria. The aim of this study was the development of a score for predicting survival of asymptomatic patients after CEA. Methods: Our score was derived from a retrospective analysis of 648 consecutive asymptomatic patients from a single hospital. External validation of the score was then performed on a second cohort of 334 asymptomatic patients from two different hospitals in the same area. Factors associated with reduced postoperative survival within the derivation cohort (DC) were identified and tested for statistical significance. Each selected factor was assigned a score proportional to its β coefficient: 1 point for chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and lack of statin treatment; 4 points for age 70 to 79 years and creatinine concentration ≥1.5 mg/dL; 8 points for age ≥80 years and dialysis. The DC was divided into four groups based on individual scores: group 1, 0 to 3 points; group 2, 4 to 7 points; group 3, 8 to 11 points; and group 4, ≥12 points. Group-specific survival curves were calculated. The validation cohort (VC) was stratified according to the score. Survival of each of the four risk groups within the VC was compared with its analogue from the DC. Results: Median follow-up of the DC and VC was, respectively, 56 and 65 months. Intercohort comparison of 5-year survival was 84.7% ± 1.7% vs 85.2% ± 2% (P = .41). Group-specific 5-year survival within the DC was 97% ± 1.5% (group 1), 88.4% ± 2.2% (group 2), 69.6% ± 4.7% (group 3), and 48.1% ± 13.5% (group 4; P < .0001). Five-year survival within the VC was 95.5% ± 2% (group 1), 89.5% ± 2.7% (group 2), 65% ± 6.1% (group 3), and 44.8% ± 14.1% (group 4; P < .0001). Intercohort comparison of group-specific survival curves showed close similarity throughout the groups. Conclusions: Our score is a simple clinical tool that allows a quick and reliable prediction of survival in asymptomatic patients who are candidates for CEA. This selective approach is crucial to avoid unnecessary surgery on patients who are less likely to survive long enough to experience the benefits of this preventive procedure.

Original languageEnglish
Pages (from-to)175-182
JournalJournal of Vascular Surgery
Volume67
Issue number1
DOIs
Publication statusPublished - 2018

Fingerprint

Carotid Endarterectomy
Life Expectancy
Survival
Unnecessary Procedures
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Carotid Stenosis
Chronic Obstructive Pulmonary Disease
Patient Selection
Coronary Artery Disease
Dialysis
Creatinine
Diabetes Mellitus

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Development and validation of a score to predict life expectancy after carotid endarterectomy in asymptomatic patients. / Carmo, Michele; Barbetta, Iacopo; Bissacco, Daniele; Trimarchi, Santi; Catanese, Vincenzo; Bonzini, Matteo; Bonardelli, Stefano; Settembrini, Piergiorgio G.

In: Journal of Vascular Surgery, Vol. 67, No. 1, 2018, p. 175-182.

Research output: Contribution to journalArticle

Carmo, M, Barbetta, I, Bissacco, D, Trimarchi, S, Catanese, V, Bonzini, M, Bonardelli, S & Settembrini, PG 2018, 'Development and validation of a score to predict life expectancy after carotid endarterectomy in asymptomatic patients', Journal of Vascular Surgery, vol. 67, no. 1, pp. 175-182. https://doi.org/10.1016/j.jvs.2017.05.107
Carmo, Michele ; Barbetta, Iacopo ; Bissacco, Daniele ; Trimarchi, Santi ; Catanese, Vincenzo ; Bonzini, Matteo ; Bonardelli, Stefano ; Settembrini, Piergiorgio G. / Development and validation of a score to predict life expectancy after carotid endarterectomy in asymptomatic patients. In: Journal of Vascular Surgery. 2018 ; Vol. 67, No. 1. pp. 175-182.
@article{d717ca6c84fe4cf397ea9a813a003678,
title = "Development and validation of a score to predict life expectancy after carotid endarterectomy in asymptomatic patients",
abstract = "Objective: Recent improvement of best medical treatment for carotid stenosis has sparked a debate on the role of surgery identification of patients who may benefit from carotid endarterectomy (CEA) is crucial to avoid overtreatment. An expected 5-year postoperative survival is one of the main selection criteria. The aim of this study was the development of a score for predicting survival of asymptomatic patients after CEA. Methods: Our score was derived from a retrospective analysis of 648 consecutive asymptomatic patients from a single hospital. External validation of the score was then performed on a second cohort of 334 asymptomatic patients from two different hospitals in the same area. Factors associated with reduced postoperative survival within the derivation cohort (DC) were identified and tested for statistical significance. Each selected factor was assigned a score proportional to its β coefficient: 1 point for chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and lack of statin treatment; 4 points for age 70 to 79 years and creatinine concentration ≥1.5 mg/dL; 8 points for age ≥80 years and dialysis. The DC was divided into four groups based on individual scores: group 1, 0 to 3 points; group 2, 4 to 7 points; group 3, 8 to 11 points; and group 4, ≥12 points. Group-specific survival curves were calculated. The validation cohort (VC) was stratified according to the score. Survival of each of the four risk groups within the VC was compared with its analogue from the DC. Results: Median follow-up of the DC and VC was, respectively, 56 and 65 months. Intercohort comparison of 5-year survival was 84.7{\%} ± 1.7{\%} vs 85.2{\%} ± 2{\%} (P = .41). Group-specific 5-year survival within the DC was 97{\%} ± 1.5{\%} (group 1), 88.4{\%} ± 2.2{\%} (group 2), 69.6{\%} ± 4.7{\%} (group 3), and 48.1{\%} ± 13.5{\%} (group 4; P < .0001). Five-year survival within the VC was 95.5{\%} ± 2{\%} (group 1), 89.5{\%} ± 2.7{\%} (group 2), 65{\%} ± 6.1{\%} (group 3), and 44.8{\%} ± 14.1{\%} (group 4; P < .0001). Intercohort comparison of group-specific survival curves showed close similarity throughout the groups. Conclusions: Our score is a simple clinical tool that allows a quick and reliable prediction of survival in asymptomatic patients who are candidates for CEA. This selective approach is crucial to avoid unnecessary surgery on patients who are less likely to survive long enough to experience the benefits of this preventive procedure.",
author = "Michele Carmo and Iacopo Barbetta and Daniele Bissacco and Santi Trimarchi and Vincenzo Catanese and Matteo Bonzini and Stefano Bonardelli and Settembrini, {Piergiorgio G.}",
year = "2018",
doi = "10.1016/j.jvs.2017.05.107",
language = "English",
volume = "67",
pages = "175--182",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Development and validation of a score to predict life expectancy after carotid endarterectomy in asymptomatic patients

AU - Carmo, Michele

AU - Barbetta, Iacopo

AU - Bissacco, Daniele

AU - Trimarchi, Santi

AU - Catanese, Vincenzo

AU - Bonzini, Matteo

AU - Bonardelli, Stefano

AU - Settembrini, Piergiorgio G.

PY - 2018

Y1 - 2018

N2 - Objective: Recent improvement of best medical treatment for carotid stenosis has sparked a debate on the role of surgery identification of patients who may benefit from carotid endarterectomy (CEA) is crucial to avoid overtreatment. An expected 5-year postoperative survival is one of the main selection criteria. The aim of this study was the development of a score for predicting survival of asymptomatic patients after CEA. Methods: Our score was derived from a retrospective analysis of 648 consecutive asymptomatic patients from a single hospital. External validation of the score was then performed on a second cohort of 334 asymptomatic patients from two different hospitals in the same area. Factors associated with reduced postoperative survival within the derivation cohort (DC) were identified and tested for statistical significance. Each selected factor was assigned a score proportional to its β coefficient: 1 point for chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and lack of statin treatment; 4 points for age 70 to 79 years and creatinine concentration ≥1.5 mg/dL; 8 points for age ≥80 years and dialysis. The DC was divided into four groups based on individual scores: group 1, 0 to 3 points; group 2, 4 to 7 points; group 3, 8 to 11 points; and group 4, ≥12 points. Group-specific survival curves were calculated. The validation cohort (VC) was stratified according to the score. Survival of each of the four risk groups within the VC was compared with its analogue from the DC. Results: Median follow-up of the DC and VC was, respectively, 56 and 65 months. Intercohort comparison of 5-year survival was 84.7% ± 1.7% vs 85.2% ± 2% (P = .41). Group-specific 5-year survival within the DC was 97% ± 1.5% (group 1), 88.4% ± 2.2% (group 2), 69.6% ± 4.7% (group 3), and 48.1% ± 13.5% (group 4; P < .0001). Five-year survival within the VC was 95.5% ± 2% (group 1), 89.5% ± 2.7% (group 2), 65% ± 6.1% (group 3), and 44.8% ± 14.1% (group 4; P < .0001). Intercohort comparison of group-specific survival curves showed close similarity throughout the groups. Conclusions: Our score is a simple clinical tool that allows a quick and reliable prediction of survival in asymptomatic patients who are candidates for CEA. This selective approach is crucial to avoid unnecessary surgery on patients who are less likely to survive long enough to experience the benefits of this preventive procedure.

AB - Objective: Recent improvement of best medical treatment for carotid stenosis has sparked a debate on the role of surgery identification of patients who may benefit from carotid endarterectomy (CEA) is crucial to avoid overtreatment. An expected 5-year postoperative survival is one of the main selection criteria. The aim of this study was the development of a score for predicting survival of asymptomatic patients after CEA. Methods: Our score was derived from a retrospective analysis of 648 consecutive asymptomatic patients from a single hospital. External validation of the score was then performed on a second cohort of 334 asymptomatic patients from two different hospitals in the same area. Factors associated with reduced postoperative survival within the derivation cohort (DC) were identified and tested for statistical significance. Each selected factor was assigned a score proportional to its β coefficient: 1 point for chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and lack of statin treatment; 4 points for age 70 to 79 years and creatinine concentration ≥1.5 mg/dL; 8 points for age ≥80 years and dialysis. The DC was divided into four groups based on individual scores: group 1, 0 to 3 points; group 2, 4 to 7 points; group 3, 8 to 11 points; and group 4, ≥12 points. Group-specific survival curves were calculated. The validation cohort (VC) was stratified according to the score. Survival of each of the four risk groups within the VC was compared with its analogue from the DC. Results: Median follow-up of the DC and VC was, respectively, 56 and 65 months. Intercohort comparison of 5-year survival was 84.7% ± 1.7% vs 85.2% ± 2% (P = .41). Group-specific 5-year survival within the DC was 97% ± 1.5% (group 1), 88.4% ± 2.2% (group 2), 69.6% ± 4.7% (group 3), and 48.1% ± 13.5% (group 4; P < .0001). Five-year survival within the VC was 95.5% ± 2% (group 1), 89.5% ± 2.7% (group 2), 65% ± 6.1% (group 3), and 44.8% ± 14.1% (group 4; P < .0001). Intercohort comparison of group-specific survival curves showed close similarity throughout the groups. Conclusions: Our score is a simple clinical tool that allows a quick and reliable prediction of survival in asymptomatic patients who are candidates for CEA. This selective approach is crucial to avoid unnecessary surgery on patients who are less likely to survive long enough to experience the benefits of this preventive procedure.

UR - http://www.scopus.com/inward/record.url?scp=85029681941&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029681941&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2017.05.107

DO - 10.1016/j.jvs.2017.05.107

M3 - Article

AN - SCOPUS:85029681941

VL - 67

SP - 175

EP - 182

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 1

ER -