Factors associated with mortality in patients with asymptomatic carotid stenosis: Results from the ACSRS study

S. K. Kakkos; A. N. Nicolaides; M. Griffin; M. Sabetai; S. Dhanjil; D. J. Thomas; T. Sonecha; A. M. Salmasi; G. Geroulakos; N. Georgiou; S. Francis; E. Ioannidou; C. J. Dore; R. Adovasio; B. Ziani; F. P. Alò; C. G. Cicilioni; G. Ambrosio; A. Andreev; G. M. Andreozzi; F. Verlato; G. Camporese; E. Arosio; E. Barkauskas; A. A.B. Barros D'Sa; P. Brannigan; V. Batchvarova; A. Dramov; P. Belardi; G. P. Novelli; G. Simoni; P. Bell; G. M. Biasi; P. Mingazzini; N. M. Bornstein; D. Bouchier-Hayes; P. Fitzgerald; M. A. Cairols; P. G. Cao; P. DeRango; G. P. Carboni; C. Geoffredo; M. Catalano; B. Chambers; M. Goetzmann; A. Dickinson; D. Clement; M. Bobelyn; S. Coccheri; E. Conti; E. Diamantopolous; E. A. Andreadis; P. B. Dimakakos; T. Kotsis; B. Eikelboom; L. Entz; Ferrari-Bardile; T. Aloi; M. Salerno; J. Fernandez e Fernandez; L. Pedro; D. E. Fitzgerald; A. O'Shaunnersy; J. Fletcher; S. Forconi; R. Cappeli; M. Bicchi; S. Arigucci; V. Gallai; G. Cardaiolli; G. Geroulakos; L. F. Gomez-Isaza; G. Gorgoyannis; N. Liasis; M. Graf; P. Guarini; S. Hardy; P. Harris; S. Aston; G. Iosa; A. Katsamouris; A. Glannoukas; M. Krzanowski; G. Ladurner; J. Leal-Monedero; B. B. Lee; C. Liapis; P. Galanis; W. Liboni; E. Pavanelli; E. Mannarino; G. Vaudo; P. McCollum; R. Levison; G. Micieli; D. Bosone; L. Middleton; M. Pantziaris

Factors associated with mortality in patients with asymptomatic carotid stenosis: Results from the ACSRS study

S. K. Kakkos, A. N. Nicolaides^*, M. Griffin, M. Sabetai, S. Dhanjil, D. J. Thomas, T. Sonecha, A. M. Salmasi, G. Geroulakos, N. Georgiou, S. Francis, E. Ioannidou, C. J. Dore, R. Adovasio, B. Ziani, F. P. Alò, C. G. Cicilioni, G. Ambrosio, A. Andreev, G. M. AndreozziF. Verlato, G. Camporese, E. Arosio, E. Barkauskas, A. A.B. Barros D'Sa, P. Brannigan, V. Batchvarova, A. Dramov, P. Belardi, G. P. Novelli, G. Simoni, P. Bell, G. M. Biasi, P. Mingazzini, N. M. Bornstein, D. Bouchier-Hayes, P. Fitzgerald, M. A. Cairols, P. G. Cao, P. DeRango, G. P. Carboni, C. Geoffredo, M. Catalano, B. Chambers, M. Goetzmann, A. Dickinson, D. Clement, M. Bobelyn, S. Coccheri, E. Conti, E. Diamantopolous, E. A. Andreadis, P. B. Dimakakos, T. Kotsis, B. Eikelboom, L. Entz, Ferrari-Bardile, T. Aloi, M. Salerno, J. Fernandez e Fernandez, L. Pedro, D. E. Fitzgerald, A. O'Shaunnersy, J. Fletcher, S. Forconi, R. Cappeli, M. Bicchi, S. Arigucci, V. Gallai, G. Cardaiolli, G. Geroulakos, L. F. Gomez-Isaza, G. Gorgoyannis, N. Liasis, M. Graf, P. Guarini, S. Hardy, P. Harris, S. Aston, G. Iosa, A. Katsamouris, A. Glannoukas, M. Krzanowski, G. Ladurner, J. Leal-Monedero, B. B. Lee, C. Liapis, P. Galanis, W. Liboni, E. Pavanelli, E. Mannarino, G. Vaudo, P. McCollum, R. Levison, G. Micieli, D. Bosone, L. Middleton, M. Pantziaris

^*Corresponding author for this work

Clinical Departments

Research output: Contribution to journal › Article › peer-review

27 Scopus citations

Abstract

Aim. This study determines the factors associated with mortality in patients with asymptomatic carotid stenosis. Methods. Patients (n=1 101) with asymptomatic internal carotid artery stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6 to 84 (median 38) months. Stenosis was graded using duplex scanning and expressed as a percentage of the carotid bulb diameter. Clinical and biochemical risk factors were recorded. The end-points were ipsilateral ischemic stroke, cardiovascular death and all cause mortality. Results. In a Cox multivariate analysis 6 factors emerged as independent predictors of risk. Age, male gender, cardiac failure, left ventricular hypertrophy on electrocardiogram (ECG) and myocardial ischemia on ECG were associated with increased risk. Antiplatelet therapy was associated with decreased risk. Based on these risk factors a high-risk group consisting of one third of the population with a 40% cumulative cardiovascular death rate and a 66% all cause death rate at 7 years could be identified. The remaining 2/3 consisted of a low-risk group with a 10% cumulative cardiovascular death rate and a 21% all cause death rate at 7 years (P<0.0001 compared to the high risk group). There was not any significant difference in the cumulative ipsilateral stroke rate, which was 12% in the low and 13% in the high cardiovascular risk group (Log Rank P>0.05). Conclusion. The methodology and findings from the ACSRS natural history study need to be applied to randomized controlled trials on the value of carotid endarterectomy or stenting in patients with asymptomatic carotid stenosis. They may help refine the indications for intervention in patients with carotid endarterectomy.

Original language	English
Pages (from-to)	221-230
Number of pages	10
Journal	International Angiology
Volume	24
Issue number	3
State	Published - Sep 2005

Keywords

Carotid stenosis
Risk factors
Stroke

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Cite this

Kakkos, S. K., Nicolaides, A. N., Griffin, M., Sabetai, M., Dhanjil, S., Thomas, D. J., Sonecha, T., Salmasi, A. M., Geroulakos, G., Georgiou, N., Francis, S., Ioannidou, E., Dore, C. J., Adovasio, R., Ziani, B., Alò, F. P., Cicilioni, C. G., Ambrosio, G., Andreev, A., ... Pantziaris, M. (2005). Factors associated with mortality in patients with asymptomatic carotid stenosis: Results from the ACSRS study. International Angiology, 24(3), 221-230.

@article{2692c2071a1049a9801747203489fd8f,

title = "Factors associated with mortality in patients with asymptomatic carotid stenosis: Results from the ACSRS study",

abstract = "Aim. This study determines the factors associated with mortality in patients with asymptomatic carotid stenosis. Methods. Patients (n=1 101) with asymptomatic internal carotid artery stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6 to 84 (median 38) months. Stenosis was graded using duplex scanning and expressed as a percentage of the carotid bulb diameter. Clinical and biochemical risk factors were recorded. The end-points were ipsilateral ischemic stroke, cardiovascular death and all cause mortality. Results. In a Cox multivariate analysis 6 factors emerged as independent predictors of risk. Age, male gender, cardiac failure, left ventricular hypertrophy on electrocardiogram (ECG) and myocardial ischemia on ECG were associated with increased risk. Antiplatelet therapy was associated with decreased risk. Based on these risk factors a high-risk group consisting of one third of the population with a 40% cumulative cardiovascular death rate and a 66% all cause death rate at 7 years could be identified. The remaining 2/3 consisted of a low-risk group with a 10% cumulative cardiovascular death rate and a 21% all cause death rate at 7 years (P<0.0001 compared to the high risk group). There was not any significant difference in the cumulative ipsilateral stroke rate, which was 12% in the low and 13% in the high cardiovascular risk group (Log Rank P>0.05). Conclusion. The methodology and findings from the ACSRS natural history study need to be applied to randomized controlled trials on the value of carotid endarterectomy or stenting in patients with asymptomatic carotid stenosis. They may help refine the indications for intervention in patients with carotid endarterectomy.",

keywords = "Carotid stenosis, Risk factors, Stroke",

author = "Kakkos, {S. K.} and Nicolaides, {A. N.} and M. Griffin and M. Sabetai and S. Dhanjil and Thomas, {D. J.} and T. Sonecha and Salmasi, {A. M.} and G. Geroulakos and N. Georgiou and S. Francis and E. Ioannidou and Dore, {C. J.} and R. Adovasio and B. Ziani and Al{\`o}, {F. P.} and Cicilioni, {C. G.} and G. Ambrosio and A. Andreev and Andreozzi, {G. M.} and F. Verlato and G. Camporese and E. Arosio and E. Barkauskas and {Barros D'Sa}, {A. A.B.} and P. Brannigan and V. Batchvarova and A. Dramov and P. Belardi and Novelli, {G. P.} and G. Simoni and P. Bell and Biasi, {G. M.} and P. Mingazzini and Bornstein, {N. M.} and D. Bouchier-Hayes and P. Fitzgerald and Cairols, {M. A.} and Cao, {P. G.} and P. DeRango and Carboni, {G. P.} and C. Geoffredo and M. Catalano and B. Chambers and M. Goetzmann and A. Dickinson and D. Clement and M. Bobelyn and S. Coccheri and E. Conti and E. Diamantopolous and Andreadis, {E. A.} and Dimakakos, {P. B.} and T. Kotsis and B. Eikelboom and L. Entz and Ferrari-Bardile and T. Aloi and M. Salerno and {Fernandez e Fernandez}, J. and L. Pedro and Fitzgerald, {D. E.} and A. O'Shaunnersy and J. Fletcher and S. Forconi and R. Cappeli and M. Bicchi and S. Arigucci and V. Gallai and G. Cardaiolli and G. Geroulakos and Gomez-Isaza, {L. F.} and G. Gorgoyannis and N. Liasis and M. Graf and P. Guarini and S. Hardy and P. Harris and S. Aston and G. Iosa and A. Katsamouris and A. Glannoukas and M. Krzanowski and G. Ladurner and J. Leal-Monedero and Lee, {B. B.} and C. Liapis and P. Galanis and W. Liboni and E. Pavanelli and E. Mannarino and G. Vaudo and P. McCollum and R. Levison and G. Micieli and D. Bosone and L. Middleton and M. Pantziaris",

year = "2005",

month = sep,

language = "אנגלית",

volume = "24",

pages = "221--230",

journal = "International Angiology",

issn = "0392-9590",

publisher = "Edizioni Minerva Medica S.p.A.",

number = "3",

}

Kakkos, SK, Nicolaides, AN, Griffin, M, Sabetai, M, Dhanjil, S, Thomas, DJ, Sonecha, T, Salmasi, AM, Geroulakos, G, Georgiou, N, Francis, S, Ioannidou, E, Dore, CJ, Adovasio, R, Ziani, B, Alò, FP, Cicilioni, CG, Ambrosio, G, Andreev, A, Andreozzi, GM, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, Barros D'Sa, AAB, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, GP, Simoni, G, Bell, P, Biasi, GM, Mingazzini, P, Bornstein, NM, Bouchier-Hayes, D, Fitzgerald, P, Cairols, MA, Cao, PG, DeRango, P, Carboni, GP, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopolous, E, Andreadis, EA, Dimakakos, PB, Kotsis, T, Eikelboom, B, Entz, L, Ferrari-Bardile, Aloi, T, Salerno, M, Fernandez e Fernandez, J, Pedro, L, Fitzgerald, DE, O'Shaunnersy, A, Fletcher, J, Forconi, S, Cappeli, R, Bicchi, M, Arigucci, S, Gallai, V, Cardaiolli, G, Geroulakos, G, Gomez-Isaza, LF, Gorgoyannis, G, Liasis, N, Graf, M, Guarini, P, Hardy, S, Harris, P, Aston, S, Iosa, G, Katsamouris, A, Glannoukas, A, Krzanowski, M, Ladurner, G, Leal-Monedero, J, Lee, BB, Liapis, C, Galanis, P, Liboni, W, Pavanelli, E, Mannarino, E, Vaudo, G, McCollum, P, Levison, R, Micieli, G, Bosone, D, Middleton, L & Pantziaris, M 2005, 'Factors associated with mortality in patients with asymptomatic carotid stenosis: Results from the ACSRS study', International Angiology, vol. 24, no. 3, pp. 221-230.

TY - JOUR

T1 - Factors associated with mortality in patients with asymptomatic carotid stenosis

T2 - Results from the ACSRS study

AU - Kakkos, S. K.

AU - Nicolaides, A. N.

AU - Griffin, M.

AU - Sabetai, M.

AU - Dhanjil, S.

AU - Thomas, D. J.

AU - Sonecha, T.

AU - Salmasi, A. M.

AU - Geroulakos, G.

AU - Georgiou, N.

AU - Francis, S.

AU - Ioannidou, E.

AU - Dore, C. J.

AU - Adovasio, R.

AU - Ziani, B.

AU - Alò, F. P.

AU - Cicilioni, C. G.

AU - Ambrosio, G.

AU - Andreev, A.

AU - Andreozzi, G. M.

AU - Verlato, F.

AU - Camporese, G.

AU - Arosio, E.

AU - Barkauskas, E.

AU - Barros D'Sa, A. A.B.

AU - Brannigan, P.

AU - Batchvarova, V.

AU - Dramov, A.

AU - Belardi, P.

AU - Novelli, G. P.

AU - Simoni, G.

AU - Bell, P.

AU - Biasi, G. M.

AU - Mingazzini, P.

AU - Bornstein, N. M.

AU - Bouchier-Hayes, D.

AU - Fitzgerald, P.

AU - Cairols, M. A.

AU - Cao, P. G.

AU - DeRango, P.

AU - Carboni, G. P.

AU - Geoffredo, C.

AU - Catalano, M.

AU - Chambers, B.

AU - Goetzmann, M.

AU - Dickinson, A.

AU - Clement, D.

AU - Bobelyn, M.

AU - Coccheri, S.

AU - Conti, E.

AU - Diamantopolous, E.

AU - Andreadis, E. A.

AU - Dimakakos, P. B.

AU - Kotsis, T.

AU - Eikelboom, B.

AU - Entz, L.

AU - Ferrari-Bardile,

AU - Aloi, T.

AU - Salerno, M.

AU - Fernandez e Fernandez, J.

AU - Pedro, L.

AU - Fitzgerald, D. E.

AU - O'Shaunnersy, A.

AU - Fletcher, J.

AU - Forconi, S.

AU - Cappeli, R.

AU - Bicchi, M.

AU - Arigucci, S.

AU - Gallai, V.

AU - Cardaiolli, G.

AU - Geroulakos, G.

AU - Gomez-Isaza, L. F.

AU - Gorgoyannis, G.

AU - Liasis, N.

AU - Graf, M.

AU - Guarini, P.

AU - Hardy, S.

AU - Harris, P.

AU - Aston, S.

AU - Iosa, G.

AU - Katsamouris, A.

AU - Glannoukas, A.

AU - Krzanowski, M.

AU - Ladurner, G.

AU - Leal-Monedero, J.

AU - Lee, B. B.

AU - Liapis, C.

AU - Galanis, P.

AU - Liboni, W.

AU - Pavanelli, E.

AU - Mannarino, E.

AU - Vaudo, G.

AU - McCollum, P.

AU - Levison, R.

AU - Micieli, G.

AU - Bosone, D.

AU - Middleton, L.

AU - Pantziaris, M.

PY - 2005/9

Y1 - 2005/9

N2 - Aim. This study determines the factors associated with mortality in patients with asymptomatic carotid stenosis. Methods. Patients (n=1 101) with asymptomatic internal carotid artery stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6 to 84 (median 38) months. Stenosis was graded using duplex scanning and expressed as a percentage of the carotid bulb diameter. Clinical and biochemical risk factors were recorded. The end-points were ipsilateral ischemic stroke, cardiovascular death and all cause mortality. Results. In a Cox multivariate analysis 6 factors emerged as independent predictors of risk. Age, male gender, cardiac failure, left ventricular hypertrophy on electrocardiogram (ECG) and myocardial ischemia on ECG were associated with increased risk. Antiplatelet therapy was associated with decreased risk. Based on these risk factors a high-risk group consisting of one third of the population with a 40% cumulative cardiovascular death rate and a 66% all cause death rate at 7 years could be identified. The remaining 2/3 consisted of a low-risk group with a 10% cumulative cardiovascular death rate and a 21% all cause death rate at 7 years (P<0.0001 compared to the high risk group). There was not any significant difference in the cumulative ipsilateral stroke rate, which was 12% in the low and 13% in the high cardiovascular risk group (Log Rank P>0.05). Conclusion. The methodology and findings from the ACSRS natural history study need to be applied to randomized controlled trials on the value of carotid endarterectomy or stenting in patients with asymptomatic carotid stenosis. They may help refine the indications for intervention in patients with carotid endarterectomy.

AB - Aim. This study determines the factors associated with mortality in patients with asymptomatic carotid stenosis. Methods. Patients (n=1 101) with asymptomatic internal carotid artery stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6 to 84 (median 38) months. Stenosis was graded using duplex scanning and expressed as a percentage of the carotid bulb diameter. Clinical and biochemical risk factors were recorded. The end-points were ipsilateral ischemic stroke, cardiovascular death and all cause mortality. Results. In a Cox multivariate analysis 6 factors emerged as independent predictors of risk. Age, male gender, cardiac failure, left ventricular hypertrophy on electrocardiogram (ECG) and myocardial ischemia on ECG were associated with increased risk. Antiplatelet therapy was associated with decreased risk. Based on these risk factors a high-risk group consisting of one third of the population with a 40% cumulative cardiovascular death rate and a 66% all cause death rate at 7 years could be identified. The remaining 2/3 consisted of a low-risk group with a 10% cumulative cardiovascular death rate and a 21% all cause death rate at 7 years (P<0.0001 compared to the high risk group). There was not any significant difference in the cumulative ipsilateral stroke rate, which was 12% in the low and 13% in the high cardiovascular risk group (Log Rank P>0.05). Conclusion. The methodology and findings from the ACSRS natural history study need to be applied to randomized controlled trials on the value of carotid endarterectomy or stenting in patients with asymptomatic carotid stenosis. They may help refine the indications for intervention in patients with carotid endarterectomy.

KW - Carotid stenosis

KW - Risk factors

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=27744452580&partnerID=8YFLogxK

M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???

AN - SCOPUS:27744452580

SN - 0392-9590

VL - 24

SP - 221

EP - 230

JO - International Angiology

JF - International Angiology

IS - 3

ER -

Factors associated with mortality in patients with asymptomatic carotid stenosis: Results from the ACSRS study

Abstract

Keywords

UN SDGs

Other files and links

Fingerprint

Cite this