Polyvascular disease influences long-term cardiovascular morbidity in carotid endarterectomy

Abstract

Introduction/Objective: Carotid stenosis (CS) is an important cause of ischemic stroke. Secondary prevention lies in performing a carotid endarterectomy (CEA) procedure, the recommended treatment in most cases. When two or more vascular regions are simultaneously affected by atherosclerosis, mainly the carotid arteries, coronary arteries, or limb arteries, a multivessel disease polyvascular disease (PVD) is present. This study aims to assess the potential role of PVD as a long-term predictor of major adverse cardiovascular events (MACE) and all-cause mortality in patients submitted to CEA. Methods: From January 2012 to December 2021, patients submitted to CEA for carotid stenosis in a tertiary care and referral center were eligible from a prospective database. A post hoc survival analysis was performed using the Kaplan-Meier survival curve method. The primary outcome was the incidence of long-term MACE and all-cause mortality. Secondary outcomes included acute myocardial infarction (AMI), major adverse limb events (MALE), stroke, and acute heart failure (AHF). Results: A total of 207 patients were enrolled, with a median follow-up of 63 months. The mean age was 70.4±8.9, and 163 (78.7%) were male. There were 65 (31.4%) patients that had two arterial vascular territories affected, and 29 (14.0%) patients had PVD in 3 arterial beds. On multivariable analysis, both MACE and all-cause mortality had as independent risk factors age (aHR 1.039, P=0.003; aHR 1.041, P=0.019), chronic kidney disease (aHR 2.524, P=0.003; aHR 3.377, P<0.001) and PVD2 (aHR 3.381, P<0.001; aHR 2.665, P=0.013). PVD1 was only associated with MACE as a statistically significant risk factor (aHR 2.531, 1.439-4.450, P<0.001). Conclusion: PVD in patients with cerebrovascular disease (CVD) was revealed to carry a two-fold increased risk for all-cause mortality and MACE during long-term follow-up. PVD may be a simple yet valuable tool in predicting all-cause mortality, MACE, AMI, and MALE after CEA.