Does Current Practice in the United States of Carotid Artery Stent Placement Benefit Asymptomatic Octogenarians?

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Fig 1.
In-hospital complication rates following revascularization for asymptomatic stenosis by age and procedure. The likelihood of in-hospital stroke, cardiac complications, or death (A) and the likelihood of in-hospital stroke or death (B) following CEA (white) or CAS (black) for 2006–2007 vary with age. Data are graphed as percentages with an adverse event plus SE.

Table 1:

Cohort characteristics by age or procedure

Table 2:

In-hospital complication rates and unadjusted ORs for all age groups

	CEA (%)	CAS (%)	Unadjusted OR (95% CI)
Primary end point
In-hospital stroke, CC, or death	2.90	3.66	1.27 (1.1–1.47)
Secondary end points
In-hospital stroke or death	1.16	1.69	1.46 (1.18–1.8)
In-hospital stroke	0.88	1.31	1.5 (1.18–1.90)
In-hospital CC	1.86	2.15	1.16 (0.96–1.39)
In-hospital death	0.39	0.57	1.46 (1.02–2.09)

Table 3:

Factors associated with morbidity or mortality multivariate analysis

Characteristics	OR for Stroke, CC, or Death (95% CI)^a	P Value	OR for Stroke or Death (95% CI)^a	P Value
Age (≥80 vs <80)	1.12 (0.97–1.30)	.06	1.17 (0.98–1.58)	.08
Procedure (CAS vs CEA)	1.12 (0.99–1.27)	.14	1.28 (1.03–1.58)	.03
Sex (female vs male)	0.97 (0.87–1.09)	NS	1.23 (1.04–1.45)	.01
Year (2007 vs 2006)	0.98 (0.88–1.09)	NS	0.95 (0.81–1.12)	NS
Race (white vs other)	Not included^b		1.14 (0.96–1.36)	NS
Comorbidities
Renal disease	1.79 (1.52–2.11)	<.0001	2.67 (2.15–3.36)	<.0001
CHF	1.67 (1.43–1.95)	<.0001	1.8 (1.43–2.27)	<.0001
COPD	1.25 (1.09–1.42)	<.01	1.26 (1.02–1.55)	.03
Diabetes	0.84 (0.74–0.94)	<.01	0.81 (0.67–0.97)	.02
Valve disease	1.40 (1.20–1.63)	<.0001	1.23 (0.96–1.57)	.1
Contralateral stenosis	1.28 (1.13–1.46)	<.001	1.3 (1.06–1.58)	.01
Hypertension	0.76 (0.68–0.86)	<.0001	0.68 (0.57–0.81)	<.0001
Tobacco	0.65 (0.57–0.74)	<.0001	0.57 (0.46–0.7)	<.0001
MI	1.25 (1.12–1.39)	<.001	1.01 (0.85–1.19)	NS
Atrial fibrillation	2.83 (2.48–3.24)	<.0001	1.62 (1.3–2.03)	<.0001
Hyperlipidemia	0.93 (0.84–1.04)	NS	0.76 (0.64–0.89)	<.001
Hospital teaching status
Teaching vs nonteaching	1.19 (1.07–1.33)	<.01	1.12 (0.95–1.31)	NS
Hospital bed size		<.05	Not included^b
Large vs small	1.24 (1.04–1.48)
Medium vs small	1.26 (1.03–1.53)

a Adjusted for comorbid conditions and demographics (see “Materials and Methods”).
b Variables were not included in the multivariate analysis because the univariate P value was >.2.