scholarly journals Risk Factors for Major Operative Complications (Myocardial Infarction, Stroke, Death) Among 4,440 Asymptomatic Patients Undergoing Carotid Endarterectomy: Pooled Analysis of VA, ACAS, ACST-1 AND GALA Trials

2019 ◽  
Vol 58 (6) ◽  
pp. e344-e345
Author(s):  
Dylan Morris ◽  
Richard Bulbulia ◽  
Hongchao Pan ◽  
Steff C. Lewis ◽  
Richard Peto ◽  
...  
2019 ◽  
Vol 10 ◽  
pp. 204062231987774 ◽  
Author(s):  
Konstantinos E Farsalinos ◽  
Riccardo Polosa ◽  
Fabio Cibella ◽  
Raymond Niaura

Background: This study analyzed the National Health Interview Surveys (NHIS) of 2016 ( n = 33,028) and 2017 ( n = 26,742) to examine whether e-cigarette use is consistently associated with myocardial infarction (MI) and coronary heart disease (CHD). Methods: Surveys were examined separately and pooled. Logistic regression analysis was used, with demographics, e-cigarette use, smoking and risk factors for CHD (hypertension, hypercholesterolemia, and diabetes) being independent variables. Former smokers were subclassified according to quit duration (⩽ 6 and > 6 years). Results: For MI, an association was observed with some days e-cigarette (but not daily) use in the 2017 survey (OR: 2.11, 95% CI: 1.14–3.88, p = 0.017). No statistically significant association was observed in the pooled analysis (daily e-cigarette use: OR: 1.35, 95% CI: 0.80–2.27, p = 0.267). For CHD, an association was observed with daily e-cigarette use in the 2016 survey (OR: 1.89, 95% CI: 1.01–3.53, p = 0.047). From the pooled analysis, no association was found between any pattern of e-cigarette use and CHD. In single-year and pooled analysis, both MI and CHD were strongly associated with all patterns of smoking, hypertension, hypercholesterolemia, diabetes, and age. Conclusions: The pooled analysis of the 2016 and 2017 NHIS showed no association between e-cigarette use and MI or CHD. The associations between established risk factors, including smoking, and both conditions were remarkably consistent. The inconsistent associations observed in single-year surveys and the cross-sectional design of the NHIS cannot substantiate any link between e-cigarette use and an elevated risk for MI or CHD. Longitudinal studies are needed to explore the effects of e-cigarette use on cardiovascular disease.


2013 ◽  
Vol 57 (2) ◽  
pp. 318-326 ◽  
Author(s):  
Prateek K. Gupta ◽  
Bala Ramanan ◽  
Jason N. MacTaggart ◽  
Abhishek Sundaram ◽  
Xiang Fang ◽  
...  

2015 ◽  
Vol 62 (6) ◽  
pp. 1680
Author(s):  
D. Doig ◽  
E.L. Turner ◽  
J. Dobson ◽  
R.L. Featherstone ◽  
G.J. de Borst ◽  
...  

1996 ◽  
Vol 3 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Christopher K. Zarins

Carotid endarterectomy has been firmly established as the gold standard of therapy for symptomatic and asymptomatic patients with severe carotid stenosis, provided surgical complication rates are within prescribed limits. The procedure-related risk of stroke/death should be < 3% in asymptomatic patients and < 6% in symptomatic patients. New investigational therapies such as balloon angioplasty and stenting for carotid stenosis should be evaluated against the same standard.


Medicina ◽  
2007 ◽  
Vol 43 (9) ◽  
pp. 685
Author(s):  
Auksė Meškauskienė ◽  
Egidijus Barkauskas ◽  
Virginija Gaigalaitė

Patients with diabetes mellitus have been shown to have an increased incidence of complications after major vascular surgery. The objective of this study was to evaluate the results of carotid endarterectomy in diabetic patients, to determine if results differ from nondiabetic patients, and to examine the risk factors for poor outcome among diabetic patients. Material and methods. We reviewed all carotid endarterectomies performed in Emergency Hospital of Vilnius University. From 1995 to 2005, 707 carotid endarterectomies were performed. Of these, 100 operations were performed in diabetic patients (14%) and the remaining 607 in nondiabetic patients. Results. Diabetic patients were younger (P<0.05) and were obese more often (P<0.001), they smoked less often (P<0.001) than nondiabetic patients. Diabetics were more likely to have severe bilateral carotid stenosis than nondiabetic patients (P<0.01). Postoperative complications (stroke) were more common in diabetic patients than in nondiabetic patients (12.0% vs. 3.4%, P<0.001) as well as intracerebral hemorrhages (3.0% vs. 0.3%, P<0.001); no perioperative myocardial infarction was found in diabetic patients. Risk factors for complications were age ≥75 (odds ratio (OR) 2.2; 95% confidence interval (CI)=1.0–4.9), smoking (OR 2.7; 95% CI=1.8– 4.2), obesity (OR 6.1; 95% CI=3.9–9.5), and bilateral carotid stenosis (OR 2.1; 95% CI=1.3–3.6). Conclusion. Diabetes mellitus significantly increased the risk of mortality and intracerebral hemorrhage but not myocardial infarction. It should be taken into consideration in making decisions about the performance and perioperative management of carotid endarterectomy.


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