Beta-blocker use is associated with lower stroke and death after carotid artery stenting

Tammam Obeid, Isibor Arhuidese, Alicia Gaidry, Umair Qazi, Christopher Joseph Abularrage, Philip Goodney, Jack Cronenwett, Mahmoud Malas

Research output: Contribution to journalArticle

Abstract

Background Proper selection of patients for carotid artery stenting (CAS) remains controversial despite multiple controlled trials. This relates in part to differences in interpretation of the relative importance of myocardial vs stroke complications after the procedure by different specialties and a lack of granular clinical data to analyze outcomes outside the large clinical trials. The objective of this study was to assess the effect of preoperative medications, procedure parameters, and patient characteristics on outcomes of CAS performed in a multispecialty national database. Methods We analyzed all patients who underwent CAS between 2005 and 2014 in the Vascular Quality Initiative. A multivariate logistic regression model was built to assess the effects of age, gender, comorbidities, smoking, preprocedure medications, procedure details, and hypotension or hypertension that required intravenous medication on 30-day death or stroke rates. Results A total of 5263 patients underwent CAS (mean age, 70 years; 63% male). The 30-day stroke/death rate was 3.4% (1.5% minor stroke, 0.9% major stroke, and 1.2% death; 40% of patients who had major strokes died within 30 days), and the myocardial infarction rate was 0.8%. Postprocedural hypertension requiring treatment occurred in 519 cases (9.9%), and it was associated with a 3.4-fold increase in stroke/death (odds ratio, 3.39; 95% confidence interval, 2.30-5.00; P 30 days was associated with a 34% reduction in the stroke/death risk (odds ratio, 0.66; 95% confidence interval, 0.46-0.95; P =.025) compared with nonuse. Beta-blocker use was not associated with postprocedural hypotension. Other predictors of postoperative stroke and death included age, symptomatic status, diabetes (type 1 or type 2), and postprocedural hypotension, whereas prior carotid endarterectomy and distal embolic protection use were protective. Conclusions Postprocedural hypertension and hypotension that require treatment are both strongly associated with periprocedural stroke/death after CAS. Beta blockers significantly reduce the stroke/death risk associated with carotid stenting and should be investigated prospectively for potential use during CAS.

Original languageEnglish (US)
Pages (from-to)363-369
Number of pages7
JournalJournal of Vascular Surgery
Volume63
Issue number2
DOIs
StatePublished - Feb 1 2016

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Carotid Arteries
Stroke
Hypotension
Odds Ratio
Hypertension
Logistic Models
Confidence Intervals
Preoperative Care
Carotid Endarterectomy
Type 1 Diabetes Mellitus
Patient Selection
Blood Vessels
Comorbidity
Smoking
Myocardial Infarction
Clinical Trials
Databases
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Beta-blocker use is associated with lower stroke and death after carotid artery stenting. / Obeid, Tammam; Arhuidese, Isibor; Gaidry, Alicia; Qazi, Umair; Abularrage, Christopher Joseph; Goodney, Philip; Cronenwett, Jack; Malas, Mahmoud.

In: Journal of Vascular Surgery, Vol. 63, No. 2, 01.02.2016, p. 363-369.

Research output: Contribution to journalArticle

Obeid, T, Arhuidese, I, Gaidry, A, Qazi, U, Abularrage, CJ, Goodney, P, Cronenwett, J & Malas, M 2016, 'Beta-blocker use is associated with lower stroke and death after carotid artery stenting', Journal of Vascular Surgery, vol. 63, no. 2, pp. 363-369. https://doi.org/10.1016/j.jvs.2015.08.108
Obeid, Tammam ; Arhuidese, Isibor ; Gaidry, Alicia ; Qazi, Umair ; Abularrage, Christopher Joseph ; Goodney, Philip ; Cronenwett, Jack ; Malas, Mahmoud. / Beta-blocker use is associated with lower stroke and death after carotid artery stenting. In: Journal of Vascular Surgery. 2016 ; Vol. 63, No. 2. pp. 363-369.
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abstract = "Background Proper selection of patients for carotid artery stenting (CAS) remains controversial despite multiple controlled trials. This relates in part to differences in interpretation of the relative importance of myocardial vs stroke complications after the procedure by different specialties and a lack of granular clinical data to analyze outcomes outside the large clinical trials. The objective of this study was to assess the effect of preoperative medications, procedure parameters, and patient characteristics on outcomes of CAS performed in a multispecialty national database. Methods We analyzed all patients who underwent CAS between 2005 and 2014 in the Vascular Quality Initiative. A multivariate logistic regression model was built to assess the effects of age, gender, comorbidities, smoking, preprocedure medications, procedure details, and hypotension or hypertension that required intravenous medication on 30-day death or stroke rates. Results A total of 5263 patients underwent CAS (mean age, 70 years; 63{\%} male). The 30-day stroke/death rate was 3.4{\%} (1.5{\%} minor stroke, 0.9{\%} major stroke, and 1.2{\%} death; 40{\%} of patients who had major strokes died within 30 days), and the myocardial infarction rate was 0.8{\%}. Postprocedural hypertension requiring treatment occurred in 519 cases (9.9{\%}), and it was associated with a 3.4-fold increase in stroke/death (odds ratio, 3.39; 95{\%} confidence interval, 2.30-5.00; P 30 days was associated with a 34{\%} reduction in the stroke/death risk (odds ratio, 0.66; 95{\%} confidence interval, 0.46-0.95; P =.025) compared with nonuse. Beta-blocker use was not associated with postprocedural hypotension. Other predictors of postoperative stroke and death included age, symptomatic status, diabetes (type 1 or type 2), and postprocedural hypotension, whereas prior carotid endarterectomy and distal embolic protection use were protective. Conclusions Postprocedural hypertension and hypotension that require treatment are both strongly associated with periprocedural stroke/death after CAS. Beta blockers significantly reduce the stroke/death risk associated with carotid stenting and should be investigated prospectively for potential use during CAS.",
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T1 - Beta-blocker use is associated with lower stroke and death after carotid artery stenting

AU - Obeid, Tammam

AU - Arhuidese, Isibor

AU - Gaidry, Alicia

AU - Qazi, Umair

AU - Abularrage, Christopher Joseph

AU - Goodney, Philip

AU - Cronenwett, Jack

AU - Malas, Mahmoud

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background Proper selection of patients for carotid artery stenting (CAS) remains controversial despite multiple controlled trials. This relates in part to differences in interpretation of the relative importance of myocardial vs stroke complications after the procedure by different specialties and a lack of granular clinical data to analyze outcomes outside the large clinical trials. The objective of this study was to assess the effect of preoperative medications, procedure parameters, and patient characteristics on outcomes of CAS performed in a multispecialty national database. Methods We analyzed all patients who underwent CAS between 2005 and 2014 in the Vascular Quality Initiative. A multivariate logistic regression model was built to assess the effects of age, gender, comorbidities, smoking, preprocedure medications, procedure details, and hypotension or hypertension that required intravenous medication on 30-day death or stroke rates. Results A total of 5263 patients underwent CAS (mean age, 70 years; 63% male). The 30-day stroke/death rate was 3.4% (1.5% minor stroke, 0.9% major stroke, and 1.2% death; 40% of patients who had major strokes died within 30 days), and the myocardial infarction rate was 0.8%. Postprocedural hypertension requiring treatment occurred in 519 cases (9.9%), and it was associated with a 3.4-fold increase in stroke/death (odds ratio, 3.39; 95% confidence interval, 2.30-5.00; P 30 days was associated with a 34% reduction in the stroke/death risk (odds ratio, 0.66; 95% confidence interval, 0.46-0.95; P =.025) compared with nonuse. Beta-blocker use was not associated with postprocedural hypotension. Other predictors of postoperative stroke and death included age, symptomatic status, diabetes (type 1 or type 2), and postprocedural hypotension, whereas prior carotid endarterectomy and distal embolic protection use were protective. Conclusions Postprocedural hypertension and hypotension that require treatment are both strongly associated with periprocedural stroke/death after CAS. Beta blockers significantly reduce the stroke/death risk associated with carotid stenting and should be investigated prospectively for potential use during CAS.

AB - Background Proper selection of patients for carotid artery stenting (CAS) remains controversial despite multiple controlled trials. This relates in part to differences in interpretation of the relative importance of myocardial vs stroke complications after the procedure by different specialties and a lack of granular clinical data to analyze outcomes outside the large clinical trials. The objective of this study was to assess the effect of preoperative medications, procedure parameters, and patient characteristics on outcomes of CAS performed in a multispecialty national database. Methods We analyzed all patients who underwent CAS between 2005 and 2014 in the Vascular Quality Initiative. A multivariate logistic regression model was built to assess the effects of age, gender, comorbidities, smoking, preprocedure medications, procedure details, and hypotension or hypertension that required intravenous medication on 30-day death or stroke rates. Results A total of 5263 patients underwent CAS (mean age, 70 years; 63% male). The 30-day stroke/death rate was 3.4% (1.5% minor stroke, 0.9% major stroke, and 1.2% death; 40% of patients who had major strokes died within 30 days), and the myocardial infarction rate was 0.8%. Postprocedural hypertension requiring treatment occurred in 519 cases (9.9%), and it was associated with a 3.4-fold increase in stroke/death (odds ratio, 3.39; 95% confidence interval, 2.30-5.00; P 30 days was associated with a 34% reduction in the stroke/death risk (odds ratio, 0.66; 95% confidence interval, 0.46-0.95; P =.025) compared with nonuse. Beta-blocker use was not associated with postprocedural hypotension. Other predictors of postoperative stroke and death included age, symptomatic status, diabetes (type 1 or type 2), and postprocedural hypotension, whereas prior carotid endarterectomy and distal embolic protection use were protective. Conclusions Postprocedural hypertension and hypotension that require treatment are both strongly associated with periprocedural stroke/death after CAS. Beta blockers significantly reduce the stroke/death risk associated with carotid stenting and should be investigated prospectively for potential use during CAS.

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