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Verfasst von:Volkers, Eline J. [VerfasserIn]   i
 Ringleb, Peter A. [VerfasserIn]   i
Titel:Prediction models for clinical outcome after a carotid revascularization procedure
Titelzusatz:an external validation study
Verf.angabe:Eline J. Volkers, Ale Algra, L. Jaap Kappelle, Olav Jansen, George Howard, Jeroen Hendrikse, Alison Halliday, John Gregson, Gustav Fraedrich, Hans-Henning Eckstein, David Calvet, Richard Bulbulia, Martin M. Brown, Jean-Pierre Becquemin, Peter A. Ringleb, Jean-Louis Mas, Leo H. Bonati, Thomas G. Brott, Jacoba P. Greving, on behalf of the Carotid Stenosis Trialists’ Collaboration
E-Jahr:2018
Jahr:16 July 2018
Umfang:6 S.
Fussnoten:Gesehen am 27.03.2019
Titel Quelle:Enthalten in: Stroke
Ort Quelle:New York, NY : Association, 1970
Jahr Quelle:2018
Band/Heft Quelle:49(2018), 8, Seite 1880-1885
ISSN Quelle:1524-4628
Abstract:Background and Purpose- Prediction models may help physicians to stratify patients with high and low risk for periprocedural complications or long-term stroke risk after carotid artery stenting or carotid endarterectomy. We aimed to evaluate external performance of previously published prediction models for short- and long-term outcome after carotid revascularization in patients with symptomatic carotid artery stenosis. Methods- From a literature review, we selected all prediction models that used only readily available patient characteristics known before procedure initiation. Follow-up data from 2184 carotid artery stenting and 2261 carotid endarterectomy patients from 4 randomized trials (EVA-3S [Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis], SPACE [Stent-Protected Angioplasty Versus Carotid Endarterectomy], ICSS [International Carotid Stenting Study], and CREST [Carotid Revascularization Endarterectomy Versus Stenting Trial]) were used to validate 23 short-term outcome models to estimate stroke or death risk ≤30 days after the procedure and the original outcome measure for which the model was developed. Additionally, we validated 7 long-term outcome models for the original outcome measure. Predictive performance of the models was assessed with C statistics and calibration plots. Results- Stroke or death ≤30 days after the procedure occurred in 158 (7.2%) patients after carotid artery stenting and in 84 (3.7%) patients after carotid endarterectomy. Most models for short-term outcome after carotid artery stenting (n=4) or carotid endarterectomy (n=19) had poor discriminative performance (C statistics ranging from 0.49-0.64) and poor calibration with small absolute risk differences between the lowest and highest risk groups and overestimation of risk in the highest risk groups. Long-term outcome models (n=7) had a slightly better performance with C statistics ranging from 0.59 to 0.67 and reasonable calibration. Conclusions- Current models did not reliably predict outcome after carotid revascularization in a trial population of patients with symptomatic carotid stenosis. In particular, prediction of short-term outcome seemed to be difficult. Further external validation of existing prediction models or development of new prediction models is needed before such models can be used to support treatment decisions in individual patients.
DOI:doi:10.1161/STROKEAHA.117.020486
URL:Bitte beachten Sie: Dies ist ein Bibliographieeintrag. Ein Volltextzugriff für Mitglieder der Universität besteht hier nur, falls für die entsprechende Zeitschrift/den entsprechenden Sammelband ein Abonnement besteht oder es sich um einen OpenAccess-Titel handelt.

Volltext: http://dx.doi.org/10.1161/STROKEAHA.117.020486
 DOI: https://doi.org/10.1161/STROKEAHA.117.020486
Datenträger:Online-Ressource
Sprache:eng
K10plus-PPN:1662450036
Verknüpfungen:→ Zeitschrift

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