Carotid Revascularization Procedures and Perioperative Outcomes: A Multistate Analysis, 2007-2014.

OBJECTIVE: To compare in-hospital mortality, postoperative stroke, and combined stroke/mortality in carotid artery stenting (CAS) patients and carotid endarterectomy (CEA) patients. DESIGN: Retrospective observational study using data from the State Inpatient Database, Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality. SETTING: All coded CAS or CEA hospitalizations from 2007 to 2014 in California, Florida, New York, Kentucky, and Maryland. PARTICIPANTS: A total of 198,120 patients, 18 years of age or older, undergoing CAS or CEA. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcomes of the study were unadjusted rates and adjusted odds of in-hospital mortality, postoperative stroke, postoperative cardiovascular complications, and combined stroke/mortality, before and after correcting for confounders, following either CEA or CAS. In multivariate logistic regression analyses, in each successive individual year, CAS was associated with higher odds of in-hospital mortality (odds ratio [OR] ≥1.5 and p < 0.05), postoperative stroke (OR ≥1.4 and p < 0.05), and combined stroke/mortality (OR ≥1.5 and p < 0.05). Similar significant results were obtained when multivariate logistic regression was stratified by symptomatology. Carotid artery stenting was associated with higher odds of cardiovascular complications in 2012 (OR = 1.5, p < 0.05) and lower odds in 2009 (OR = 0.8, p < 0.05). CONCLUSION: This study associated carotid stenting, as compared to endarterectomy, with an increased risk of dying and/or stroke. These associations persisted after statistical adjustment for patient demographics, comorbidities, and symptomatology, as well as after post-stratification by patient symptomatology. Despite this study's large, representative sample and well-defined a priori statistical methods, further research into real-world revascularization outcomes with longer-term follow-up is needed to formulate treatment guidelines.

Rates and predictors of renewed quitting after relapse during a one-year follow-up among primary care patients.

BACKGROUND: Most people who quit smoking relapse within a year of quitting. Little is known about what prompts renewed quitting after relapse or how often this results in abstinence. PURPOSE: This study seeks to identify rates, efficacy, and predictors of renewed quit attempts after relapse during a 1-year follow-up. METHODS: Primary care patients in a comparative effectiveness trial of smoking cessation pharmacotherapies reported daily smoking every 6-12 weeks for 12 months to determine relapse, renewed quitting, and 12-month abstinence rates. RESULTS: Of 894 known relapsers, 291 (33%) renewed quitting for at least 24 h, and 99 (34%) of these were abstinent at follow-up. The average latency to renewed quitting was 106 days and longer latencies predicted greater success. Renewed quitting was more likely for older, male, less dependent smokers, and later abstinence was predicted by fewer depressive symptoms and longer past abstinence. CONCLUSIONS: Renewed quitting is common and produces meaningful levels of cessation.