Race as a predictor of morbidity, mortality, and neurologic events after carotid endarterectomy

Abstract

Black race is an independent risk factor for 30-day mortality after CEA. A significant proportion of strokes and deaths occur after discharge in both racial groups evaluated.

Race as a predictor of delay from diagnosis to endarterectomy in clinically significant carotid stenosis

“…These comorbidities were hypertension (ICD-9 401,405; HTN), coronary artery disease (ICD-9 410-414; CAD), congestive heart failure (ICD-9 428.0; CHF), chronic pulmonary disease (ICD-9 490-493; CPD), cancer in the last 5 years (ICD-9 140-149, 201-208, 238.4) peripheral vascular disease including aortic aneurysm (ICD-9 443, 443.89, 443.9, 441; PVD) and diabetes mellitus (ICD-9 250; DM). 2, 8 The Charlson Comorbidity Index (CCI) was also calculated for all patients, as a validated measure of comorbidity burden. 17 Anticipating that patients with cardiac risk factors may require preoperative workup, the presence of cardiac stress testing (CST) was also noted.…”

“…1 CEA is a valuable tool in preventing cerebrovascular accident, currently the fourth leading cause of death in the United States. 2 The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Asymptomatic Carotid Artery Stenosis (ACAS) trials of the 1990s provided high-level evidence that operative removal of carotid plaque in the presence of carotid stenosis offered a relative risk reduction in 5-year stroke and death rate. 3, 4 As these trials had a relatively small proportion of black enrollees (~3%), a number of ensuing studies have shown that black patients underwent CEA with less frequency than white patients, received fewer carotid imaging studies, and had more severe neurological disease and comorbidities preoperatively.…”

“…3, 4 As these trials had a relatively small proportion of black enrollees (~3%), a number of ensuing studies have shown that black patients underwent CEA with less frequency than white patients, received fewer carotid imaging studies, and had more severe neurological disease and comorbidities preoperatively. 2, 5-13 …”

“…CEA operations performed from 2005-2010 in the National Surgical Quality Improvement Program (NSQIP) were examined in 2013, in which black race was identified as an independent risk factor for both 30-day postoperative and in-hospital mortality. 2 Explanations for these outcomes disparities have included increased comorbidities preoperatively, poor patient selection, confounding by socioeconomic status and other non-medical factors, and increased proportion of CEA operations on black patients performed at low volume institutions, by less experienced surgeons. 2, 6, 9, 11, 15 …”

Development and Validation of a Preprocedural Risk Score to Predict Access Site Complications After Peripheral Vascular Interventions Based on the Vascular Quality Initiative Database

“…White race was predictive of bleeding, and disparity in bleeding rates among races has been previously identified in PVI, PCI and vascular interventions. 5,16,17 Nonfemoral arterial access in PVI also has been associated with ASC and may be related to transbrachial access, which is associated with puncture site complications in PCI.…”