Rates of in-hospital stroke or death vary considerably among hospitals performing carotid artery stenting (CAS) – from 0 to 18 percent overall and from 1.2 to 4.7 percent when accounting for variation in the health of patients at admission, according to a study published May 18 in JACC: Cardiovascular Interventions.

For patients with similar risk profiles, the odds of suffering stroke or death differ by about 50 percent from one facility to another, pointing to a substantial range in quality among hospitals performing CAS.  

The study was led by Beau M. Hawkins, MD, FACC, a cardiologist at the University of Oklahoma Health Sciences Center, and Robert W. Yeh, MD, a cardiologist at the Massachusetts General Hospital. Using data from the ACC’s CARE Registry – now the PVI Registry – the authors assessed 19,381 procedures from 188 hospitals, each performing more than five CAS procedures between 2005 and 2013. 

Results showed that the mean unadjusted stroke/death rate across the entire cohort was 2.4 percent, with outcomes among participating hospitals ranging from 0 percent to 18.8 percent. To account for differences in the patient mix, researchers did a second analysis that adjusted for variation in risk factors, including age, prior stroke, impending major surgery, and the presence of a heart flutter. Adjusted death and stroke rates ranged from 1.2 percent to 4.7 percent.   

The authors explain that unlike other studies, this analysis did not find a connection between procedural volume and outcomes. They suggest that this difference may be the result of therapeutic advances such as blood-clot protection devices and improved patient selection. They also speculate that hospitals participating in this study may have more comprehensive measures in place to promote patient safety, or they may have more rigorous credentialing standards for providers performing CAS. 

Hawkins and Yeh note that “our findings are important because they demonstrate that carotid stenting is being performed with good results across a large number of hospitals in the U.S. However, our analyses also suggest that some hospitals are achieving better outcomes than others, and it will be important to identify the reasons for this so that all centers offering this therapy can achieve exceptional outcomes.”

   

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Carotid Artery, Common, Credentialing, Patient Safety, Patient Selection, Registries, Risk Factors, Stents, Stroke, National Cardiovascular Data Registries, PVI Registry

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