METHODS: All patients presenting with moderate (50-69%) ASCS as determined by carotid artery duplex (01/2005-05/2012) were included. Cox proportional hazard regression models accounting for measured duplex velocities (peak systolic velocity, PSV; end diastolic velocity, EDV; ICA/CCA ratio) and previously identified risk factors for progression (age, smoking, dual antiplatelet therapy) were used to develop receiver operating characteristic (ROC) curves for predicting disease progression. RESULTS: 268 patients were analyzed (71±9 yrs, 52% male, 2.6±1.7 yrs follow-up, 25% disease progression). Initial PSV, EDV, and ICA/CCA ratio were all significant predictors of progression (Table). ROC curve analyses suggested that a prediction model including PSV, ICA/CCA ratio, age, smoking, and dual antiplatelet therapy had optimal prediction efficacy (C-statistic 0.76; Table). CONCLUSIONS: We propose a 5-variable risk prediction model that can be used to predict disease progression in patients with moderate ASCS with good sensitivity and specificity that may be useful for identifying high-risk patients requiring closer follow-up. AUTHOR DISCLOSURES: C.J. Abularrage: Nothing to disclose; I. Arhuidese: Nothing to disclose; J.K. Canner: Nothing to disclose; J.A. Freischlag: Nothing to disclose; C.W. Hicks: Nothing to disclose; M.B. Malas: Nothing to disclose; B.A. Perler: Nothing to disclose; U. Qazi: Nothing to disclose; E. Schneider: Nothing to disclose; K. Talbott: Nothing to disclose. Table: ROC Analyses of Risk Prediction Models for Disease Progression in Moderate Table: ROC Analyses of Risk Prediction Models for Disease Progression in Moderate Asymptomatic Asymptomatic Carotid Artery Stenosis Carotid Artery Stenosis
Risk of Disease Progression
C-Statistic
Unadjusted HR (95% CI)
Adjusted HR* (95% CI)
Unadjusted AUC (95% CI)
Adjusted AUC* (95% CI)
PSV
1.01 (1.01, 1.02)
1.01 (1.01, 1.02)
0.68 (0.61, 0.76)
0.71 (0.63, 0.79)
EDV
1.02 (1.01, 1.03)
1.03 (1.01, 1.04)
0.64 (0.56, 0.72)
0.68 (0.60, 0.76)
ICA/CCA Ratio
3.90 (2.19, 5.25)
3.42 (2.16, 5.41)
0.74 (0.68, 0.81)
0.75 (0.68, 0.76)
PSV + ICA/CCA
2.60 (1.59, 4.25)
2.63 (1.54, 4.47)
0.75 (0.68, 0.82)
0.76 (0.69, 0.83)
HR: hazard ratio. AUC: area under the curve. *Adjusted for age, smoking, and dual antiplatelet therapy **Model equation: Y= exp(-4.84 + 0.005PSV - 0.97ratio - 0.007Age + 0.56Smoking + 0.40Antiplatelet). RR4. Five-Year Survival Among Medicare Beneficiaries over Age 80 Undergoing Asymptomatic Carotid Endarterectomy
1:15 p.m.
Marcus E. Semel,1 Thomas T. Tsai,1 Edward A. McGillicuddy,1 C. Keith Ozaki,1 Ashish K. Jha,2 Michael Belkin.1 1 Brigham and Women’s Hospital, Boston, Mass.; 2 Harvard School of Public Health, Boston, Mass.
OBJECTIVES: Benefit from asymptomatic carotid endarterectomy (AsCEA) depends on long-term survival. We undertook this study to examine 5-year survival (5-ys) in octogenarians after AsCEA.
Vascular Annual Meeting 2014 • June 5 – 7, 2014 • Boston, Massachusetts
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