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Researchers establish new rule to predict risk of stroke, death from surgery that prevents it
Date:12/10/2010

al other medical risk factors, the upfront risk of surgery can outweigh any potential long-term benefits."

To create a predictive model to help determine a patient's risk, Dr. Halm and colleagues reviewed cases from the New York Carotid Artery Surgery study (NYCAS). The NYCAS evaluated outcomes of carotid surgeries performed on elderly patients in 167 hospitals in New York state between January 1998 and June 1999. Of the 9,308 surgeries, 6,553 were performed on asymptomatic patients. The average patient was 75 years old. Nearly 75 percent of patients had hypertension; 62 percent had coronary artery disease; and 29 percent had diabetes. Within 30 days of surgery, there were 55 deaths and 165 strokes.

The UT Southwestern researchers found that eight factors were independent predictors of death or stroke being female, a minority, or severely disabled, or having a history of stroke, having arteries narrowed more than 50 percent, coronary artery disease, congestive heart failure or valvular heart disease.

They assigned each risk factor one point, except for disability which counts as 2. Patients with a score of 0 to 2 are low risk; those with 3 points are at moderate risk; more than 4 are high risk. Using this CEA-8 rule, they determined that one-fourth of the NYCAS patients had a higher probability of death and stroke than the recommended national guidelines.

They then created the CEA-7, a patient-friendly model, that eliminates non-operative stenosis. Patients can also determine their own risk, even if they don't know whether their arteries are more than 50 percent blocked.

"These models are the first for asymptomatic patients and are a practical and easy-to-use tool for doctors and patients to evaluate what is best for them in the long term," Dr. Halm said. "These aren't the only factors a patient should consider individual health and experience of the surgeon and hospital team count, too but hopefully with these model
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Contact: LaKisha Ladson
lakisha.ladson@utsouthwestern.edu
214-648-3404
UT Southwestern Medical Center
Source:Eurekalert

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