Evaluation of Preprocedural Risk Score for CAS Is Published

September 19, 2012—Beau M. Hawkins, MD, et al published results of the use of a risk score that the investigators developed and internally validated to predict in-hospital stroke or death after carotid artery stenting (CAS). The investigators stated that a tool that accurately assesses CAS risk could aid clinical decision making and improve patient selection. The findings are available online ahead of print in the Journal of the American College of Cardiology.

In May 2012, Dr. Hawkins presented the CAS risk assessment technique at the Society for Cardiovascular Angiography and Interventions scientific sessions in Las Vegas, Nevada.

 As detailed by the investigators in the Journal of the American College of Cardiology, the evaluation included patients undergoing CAS without acute evolving stroke from April 2005 through June 2011, as part of the National Cardiovascular Data Registry (NCDR) Carotid Artery Revascularization and Endarterectomy (CARE) Registry. In-hospital stroke or death was modeled using logistic regression with 35 candidate variables. Internal validation was achieved with bootstrapping, and model discrimination and calibration were assessed.

The investigators reported that a total of 271 (2.4%) primary endpoint events occurred during 11,122 procedures. Independent predictors of stroke or death included impending major surgery, previous stroke, age, symptomatic lesion, atrial fibrillation, and absence of previous ipsilateral carotid endarterectomy. The model was well calibrated with moderate discriminatory ability (C-statistic: 0.71) overall, and within symptomatic (C-statistic: 0.68) and asymptomatic (C-statistic: 0.72) subgroups. The inclusion of available angiographic variables did not improve model performance (C-statistic: 0.72, integrated discrimination improvement 0.001; P = .21).

The NCDR CAS score, composed of six clinical variables, was developed to support prospective risk quantification, according to the investigators, who concluded that the score does predict in-hospital stroke or death after CAS. They advised that this tool may be useful to assist clinicians in evaluating optimal management, share more accurate preprocedural risks with patients, and improve patient selection for CAS.