scholarly journals Improving Outcome Prediction Accuracy of Carotid Endarterectomy (CEA) in Asymptomatic Patients Using a Novel Frailty Risk Score (FRS)◊

2014 ◽  
Vol 60 (3) ◽  
pp. 812
Author(s):  
Anton N. Sidawy ◽  
Richard F. Neville ◽  
Bao N. Nguyen ◽  
Gurusher Panjrath ◽  
Richard Amdur
Keyword(s):  
Carotid Endarterectomy ◽  
Risk Score ◽  
Prediction Accuracy ◽  
Outcome Prediction ◽  
Asymptomatic Patients

Abstract P47: Predicting Death and Stroke After Carotid Endarterectomy in Asymptomatic Patients: A Clinical Prediction Model

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Linda Calvillo-King ◽  
Song Zhang ◽  
Lei Xuan ◽  
Ethan A Halm
Keyword(s):  
Carotid Endarterectomy ◽  
Risk Score ◽  
Prediction Rule ◽  
Severe Disability ◽  
Clinical Prediction ◽  
Imaging Data ◽  
Final Model ◽  
Complication Risk ◽  
Asymptomatic Patients ◽  
History Of

Background and Purpose: National AHA guidelines on carotid endarterectomy (CEA) for asymptomatic patients (Pts) stipulate that the long term benefit of surgery is dependent on having a ≤ 3% risk of perioperative death or stroke (D/S) due to the procedure. We developed and validated a multivariate model of risk of D/S within 30 days of CEA for asymptomatic disease and a clinical prediction rule based on the final model. Methods: We analyzed data from 6553 asymptomatic cases in the New York Carotid Artery Surgery (NYCAS) study, a population-based cohort of all Medicare beneficiaries having CEA in NY State from 1/98 to 6/99. Medical records were abstracted for: sociodemographics, neurological history, carotid imaging data, comorbidities, and D/S within 30 days. All events were adjudicated. Multivariate logistic regression with GEE was used to identify independent predictors of combined D/S. The final model was cross-validated with100 random splits. A CEA-8 Clinical Risk Score assigned 1 point to each risk factor except for disability which got 2 points. Results: The 6553 CEAs were performed by 435 surgeons in 157 hospitals. Mean age was 74 years, 3655 were male, 4152 had coronary artery disease (CAD), 873 valvular disease, 611 congestive heart failure (CHF), 1453 history of distant stroke or TIA, and 93 severe disability. Nearly all (6413) had 70-90% ipsilateral stenosis, and 2469 had ≥ 50% contralateral stenosis. The combined 30 day D/S rate was 3.0% (198 of 6553). Multivariable predictors of perioperative D/S were: female (OR, 1.5; 95% CI, 1.1-1.9), non-white (OR, 1.8; 1.1-2.9), severe disability (OR, 3.7; 1.8-7.7), CHF (OR, 1.6; 1.1-2.4), CAD (OR, 1.6; 1.2- 2.2), valvular heart disease (OR, 1.5; 1.1-2.3), distant history of stroke/TIA (OR, 1.5; 1.1- 2.0), and non-operated stenosis ≥50% (OR, 1.8; 1.3-2.3). The CEA-8 Risk Score stratified Pts from a D/S rate of 0.6% (3 of 509) to 10% (16 of 159). Conclusions: Several sociodemographic, neuroseverity, and comorbidity factors predicted risk of D/S in asymptomatic patients having CEA. A CEA-8 Risk Score of ≥ 4 identifies high risk Pts (predicted D/S rate of >7.5%) with 2.5 times the AHA guideline acceptable complication risk in asymptomatic Pts (≤ 3%).

scholarly journals Moving on unconventional research fields for carotid endarterectomy in asymptomatic patients

2021 ◽  
Vol 73 (5) ◽  
pp. 1834
Author(s):  
Daniele Bissacco ◽  
Maurizio Domanin ◽  
Santi Trimarchi
Keyword(s):  
Carotid Endarterectomy ◽  
Research Fields ◽  
Asymptomatic Patients

Long-term outcomes of symptomatic and asymptomatic patients undergoing carotid endarterectomy in an average-volume community hospital

2020 ◽  
pp. 1-7
Author(s):  
José M. Alvarez Gallesio ◽  
Patricio Gimenez Ruiz ◽  
Michel David ◽  
Martin Devoto ◽  
Alejandro Caride ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Community Hospital ◽  
Long Term Outcomes ◽  
Average Volume ◽  
Asymptomatic Patients

scholarly journals Identifying individuals with high risk of Alzheimer’s disease using polygenic risk scores

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Ganna Leonenko ◽  
Emily Baker ◽  
Joshua Stevenson-Hoare ◽  
Annerieke Sierksma ◽  
Mark Fiers ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Score ◽  
Genetic Risk ◽  
Prediction Accuracy ◽  
Genetic Risk Score ◽  
Low Risk ◽  
Risk Scores ◽  
Sample Mean ◽  
Polygenic Risk ◽  
Reliable Identification

AbstractPolygenic Risk Scores (PRS) for AD offer unique possibilities for reliable identification of individuals at high and low risk of AD. However, there is little agreement in the field as to what approach should be used for genetic risk score calculations, how to model the effect of APOE, what the optimal p-value threshold (pT) for SNP selection is and how to compare scores between studies and methods. We show that the best prediction accuracy is achieved with a model with two predictors (APOE and PRS excluding APOE region) with pT<0.1 for SNP selection. Prediction accuracy in a sample across different PRS approaches is similar, but individuals’ scores and their associated ranking differ. We show that standardising PRS against the population mean, as opposed to the sample mean, makes the individuals’ scores comparable between studies. Our work highlights the best strategies for polygenic profiling when assessing individuals for AD risk.

Impact of Cognitive Dysfunction on Survival in Patients With and Without Statin Use Following Carotid Endarterectomy

Neurosurgery ◽  
2015 ◽  
Vol 77 (6) ◽  
pp. 880-887 ◽  
Author(s):  
Eric J. Heyer ◽  
Joanna L. Mergeche ◽  
Shuang Wang ◽  
John G. Gaudet ◽  
E. Sander Connolly
Keyword(s):  
Confidence Interval ◽  
Carotid Endarterectomy ◽  
Cognitive Dysfunction ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Rank Test ◽  
Term Survival ◽  
Asymptomatic Patients ◽  
Statin Use

BACKGROUND: Early cognitive dysfunction (eCD) is a subtle form of neurological injury observed in ∼25% of carotid endarterectomy (CEA) patients. Statin use is associated with a lower incidence of eCD in asymptomatic patients having CEA. OBJECTIVE: To determine whether eCD status is associated with worse long-term survival in patients taking and not taking statins. METHODS: This is a post hoc analysis of a prospective observational study of 585 CEA patients. Patients were evaluated with a battery of neuropsychometric tests before and after surgery. Survival was compared for patients with and without eCD stratifying by statin use. At enrollment, 366 patients were on statins and 219 were not. Survival was assessed by using Kaplan-Meier methods and multivariable Cox proportional hazards models. RESULTS: Age ≥75 years (P = .003), diabetes mellitus (P &lt; .001), cardiac disease (P = .02), and statin use (P = .014) are significantly associated with survival univariately (P &lt; .05) by use of the log-rank test. By Cox proportional hazards model, eCD status and survival adjusting for univariate factors within statin and nonstatin use groups suggested a significant effect by association of eCD on survival within patients not taking statin (hazard ratio, 1.61; 95% confidence interval, 1.09–2.40; P = .018), and no significant effect of eCD on survival within patients taking statin (hazard ratio, 0.98; 95% confidence interval, 0.59–1.66; P = .95). CONCLUSION: eCD is associated with shorter survival in patients not taking statins. This finding validates eCD as an important neurological outcome and suggests that eCD is a surrogate measure for overall health, comorbidity, and vulnerability to neurological insult.

Changes in CBF After Carotid Endarterectomy: Follow-up in Neurologically Asymptomatic Patients

1992 ◽  
pp. 232-236
Author(s):  
J. A. Rem ◽  
O. Gratzl ◽  
H. R. Müller ◽  
J. Müller-Brand ◽  
E. W. Radü
Keyword(s):  
Carotid Endarterectomy ◽  
Asymptomatic Patients

scholarly journals Predicting Risk of Perioperative Death and Stroke After Carotid Endarterectomy in Asymptomatic Patients

Stroke ◽  
2010 ◽  
Vol 41 (12) ◽  
pp. 2786-2794 ◽  
Author(s):  
Linda Calvillo-King ◽  
Lei Xuan ◽  
Song Zhang ◽  
Stanley Tuhrim ◽  
Ethan A. Halm
Keyword(s):  
Carotid Endarterectomy ◽  
Asymptomatic Patients

scholarly journals The Prognostic Value of Metabolic Profiling in Older Patients With a Proximal Femoral Fracture

2020 ◽  
Vol 11 ◽  
pp. 215145932096009
Author(s):  
Max P.L. van der Sijp ◽  
H. Eka D. Suchiman ◽  
Monica Eijk ◽  
Dina Vojinovic ◽  
Arthur H. P. Niggebrugge ◽  
...  
Keyword(s):  
Risk Score ◽  
Functional Recovery ◽  
Mortality Risk ◽  
Femoral Fracture ◽  
Patient Population ◽  
Prediction Accuracy ◽  
Prognostic Value ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Proximal Femoral Fractures

Introduction: High mortality rates of approximately 20% within 1 year after treatment are observed for patients with proximal femoral fractures. This preliminary study explores the prognostic value of a previously constructed mortality risk score based on a set of 14 metabolites for the survival and functional recovery in patients with proximal femoral fractures. Materials and Methods: A prospective observational cohort study was conducted including patients admitted with a proximal femoral fracture. The primary outcome was patient survival, and the recovery of independence in activities of daily living was included as a secondary outcome. The mortality risk score was constructed for each patient and its prognostic value was tested for the whole population. Results: Data was available form 136 patients. The mean age of all patients was 82.1 years, with a median follow-up of 6 months. Within this period, 19.0% of all patients died and 51.1% recovered to their prefracture level of independence. The mortality score was significantly associated with mortality (HR, 2.74; 95% CI, 1.61-4.66; P < 0.001), but showed only a fair prediction accuracy (AUC = 0.68) and a borderline significant comparison of the mortality score tertile groups in survival analyses (P = 0.049). No decisive associations were found in any of the analyses for the functional recovery of patients. Discussion: These findings support the previously determined prognostic value of the mortality risk score. However, the independent prognostic value when adjusted for potential confounding factors is yet to be assessed. Also, a risk score constructed for this specific patient population might achieve higher accuracies for the prediction of survival and functional recovery. Conclusions: A modest prediction accuracy was observed for the mortality risk score in this population. More elaborate studies are needed to validate these findings and develop a tailored model for clinical purposes in this patient population.

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