CAS and CEA Show Comparable Late Outcomes in REACH Analysis

September 14, 2010—In Circulation, Sripal Bangalore, MD, et al have published findings from a propensity-matched analysis of the REACH (Reduction of Atherothrombosis for Continued Health) registry comparing the relative efficacy of carotid endartectomy (CEA) and carotid artery stenting (CAS) in preventing late events (2010;122:1091–1100).

The REACH investigators concluded that in a real-world cohort of patients with a history of carotid artery revascularization, CAS was comparable to CEA for late outcomes.

As detailed in Circulation, the REACH registry recruited more than 68,000 outpatients of 45 years of age or older with established atherothrombotic disease or three risk factors for atherothrombosis. Patients who had undergone CAS or CEA were chosen and followed up prospectively for the occurrence of cardiovascular events. Propensity score matching was performed to assemble a cohort of patients in whom all baseline covariates would be well balanced. The primary outcome was defined as death or stroke at 2-year follow-up. The secondary outcome was stroke or transient ischemic attack. The tertiary outcome was a composite of death, myocardial infarction, or stroke and the individual outcomes.

Of the 68,236 patients with atherothrombotic disease or risk for atherothrombosis, 3,412 patients (5%) had a history of carotid artery revascularization (70% asymptomatic carotid stenosis): 1,025 (30%) with CAS and 2,387 (70%) with CEA. Propensity score analyses matched 836 CAS patients with 836 CEA patients.

The investigators reported that at the end of 2 years of follow-up, in the propensity score–matched cohort, CAS was associated with a risk similar to CEA for the primary (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.57–1.26), secondary (HR, 1.2; 95% CI, 0.73–1.96), and tertiary (HR, 0.72; 95% CI, 0.51–1.01) composite outcome, death (HR, 0.63; 95% CI, 0.4–1), and stroke (HR, 1.48; 95% CI, 0.79–2.8).