Impact of Cognitive Dysfunction on Survival in Patients With and Without Statin Use Following Carotid Endarterectomy
BACKGROUND: Early cognitive dysfunction (eCD) is a subtle form of neurological injury observed in ∼25% of carotid endarterectomy (CEA) patients. Statin use is associated with a lower incidence of eCD in asymptomatic patients having CEA. OBJECTIVE: To determine whether eCD status is associated with w...
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| Veröffentlicht in: | Neurosurgery 2015-12, Vol.77 (6), p.880-887 |
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| creator | Heyer, Eric J. Mergeche, Joanna L. Wang, Shuang Gaudet, John G. Connolly, E. Sander |
| description | BACKGROUND:
Early cognitive dysfunction (eCD) is a subtle form of neurological injury observed in ∼25% of carotid endarterectomy (CEA) patients. Statin use is associated with a lower incidence of eCD in asymptomatic patients having CEA.
OBJECTIVE:
To determine whether eCD status is associated with worse long-term survival in patients taking and not taking statins.
METHODS:
This is a post hoc analysis of a prospective observational study of 585 CEA patients. Patients were evaluated with a battery of neuropsychometric tests before and after surgery. Survival was compared for patients with and without eCD stratifying by statin use. At enrollment, 366 patients were on statins and 219 were not. Survival was assessed by using Kaplan-Meier methods and multivariable Cox proportional hazards models.
RESULTS:
Age ≥75 years (P = .003), diabetes mellitus (P < .001), cardiac disease (P = .02), and statin use (P = .014) are significantly associated with survival univariately (P < .05) by use of the log-rank test. By Cox proportional hazards model, eCD status and survival adjusting for univariate factors within statin and nonstatin use groups suggested a significant effect by association of eCD on survival within patients not taking statin (hazard ratio, 1.61; 95% confidence interval, 1.09–2.40; P = .018), and no significant effect of eCD on survival within patients taking statin (hazard ratio, 0.98; 95% confidence interval, 0.59–1.66; P = .95).
CONCLUSION:
eCD is associated with shorter survival in patients not taking statins. This finding validates eCD as an important neurological outcome and suggests that eCD is a surrogate measure for overall health, comorbidity, and vulnerability to neurological insult. |
| doi_str_mv | 10.1227/NEU.0000000000000904 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1735326479</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1227/NEU.0000000000000904</oup_id><sourcerecordid>1735326479</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4244-39693b586fa0a5363fa7a1cd56e7640180b663a70c80f7ae0c78058ef84fe0ff3</originalsourceid><addsrcrecordid>eNqNkd1rkzEYxYMork7_A5GAN7vplrz57KXUbg6GE2bRu5DmTdbM901qPlr635vZKbIbFwJ5IL9zODwHgLcYneKuE2efF8tT9O-ZIfoMTDDr6JQiip6DCcJUTsmMfz8Cr3K-QwhzKuRLcNRxgiQnbALK5bjRpsDo4DzeBl_81sKP--xqMMXHANu9qWnrt3qAPsAvungbSobffFlDHfrfQ6wF3pT2FeAyW3gehyHufLiFc51i8T1chF6nYpM1JY771-CF00O2bx7eY7A8X3ydf5peXV9czj9cTQ3tKL1PPiMrJrnTSDPCidNCY9MzbgWnCEu04pxogYxETmiLjJCISeskdRY5R47BycF3k-LPanNRo8_GDoMONtassCCMdG0ns4a-f4TexZpCS6c6wgTrGGayUfRAmRRzTtapTfKjTnuFkbpvRbVW1ONWmuzdg3ldjbb_K_pTQwPkAdjFoW0p_xjqzia1tnoo6_95nx2ksW6eluYXClumXQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2357525158</pqid></control><display><type>article</type><title>Impact of Cognitive Dysfunction on Survival in Patients With and Without Statin Use Following Carotid Endarterectomy</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Heyer, Eric J. ; Mergeche, Joanna L. ; Wang, Shuang ; Gaudet, John G. ; Connolly, E. Sander</creator><creatorcontrib>Heyer, Eric J. ; Mergeche, Joanna L. ; Wang, Shuang ; Gaudet, John G. ; Connolly, E. Sander</creatorcontrib><description>BACKGROUND:
Early cognitive dysfunction (eCD) is a subtle form of neurological injury observed in ∼25% of carotid endarterectomy (CEA) patients. Statin use is associated with a lower incidence of eCD in asymptomatic patients having CEA.
OBJECTIVE:
To determine whether eCD status is associated with worse long-term survival in patients taking and not taking statins.
METHODS:
This is a post hoc analysis of a prospective observational study of 585 CEA patients. Patients were evaluated with a battery of neuropsychometric tests before and after surgery. Survival was compared for patients with and without eCD stratifying by statin use. At enrollment, 366 patients were on statins and 219 were not. Survival was assessed by using Kaplan-Meier methods and multivariable Cox proportional hazards models.
RESULTS:
Age ≥75 years (P = .003), diabetes mellitus (P < .001), cardiac disease (P = .02), and statin use (P = .014) are significantly associated with survival univariately (P < .05) by use of the log-rank test. By Cox proportional hazards model, eCD status and survival adjusting for univariate factors within statin and nonstatin use groups suggested a significant effect by association of eCD on survival within patients not taking statin (hazard ratio, 1.61; 95% confidence interval, 1.09–2.40; P = .018), and no significant effect of eCD on survival within patients taking statin (hazard ratio, 0.98; 95% confidence interval, 0.59–1.66; P = .95).
CONCLUSION:
eCD is associated with shorter survival in patients not taking statins. This finding validates eCD as an important neurological outcome and suggests that eCD is a surrogate measure for overall health, comorbidity, and vulnerability to neurological insult.</description><identifier>ISSN: 0148-396X</identifier><identifier>EISSN: 1524-4040</identifier><identifier>DOI: 10.1227/NEU.0000000000000904</identifier><identifier>PMID: 26308635</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Aged ; Carotid Stenosis - mortality ; Carotid Stenosis - psychology ; Carotid Stenosis - surgery ; Cognition Disorders - epidemiology ; Comorbidity ; Confidence intervals ; Endarterectomy, Carotid - adverse effects ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Incidence ; Male ; Middle Aged ; Neurosurgery ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Statins ; Treatment Outcome</subject><ispartof>Neurosurgery, 2015-12, Vol.77 (6), p.880-887</ispartof><rights>Copyright © 2015 by the Congress of Neurological Surgeons 2015</rights><rights>Copyright © by the Congress of Neurological Surgeons</rights><rights>Copyright © 2015 by the Congress of Neurological Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4244-39693b586fa0a5363fa7a1cd56e7640180b663a70c80f7ae0c78058ef84fe0ff3</citedby><cites>FETCH-LOGICAL-c4244-39693b586fa0a5363fa7a1cd56e7640180b663a70c80f7ae0c78058ef84fe0ff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26308635$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Heyer, Eric J.</creatorcontrib><creatorcontrib>Mergeche, Joanna L.</creatorcontrib><creatorcontrib>Wang, Shuang</creatorcontrib><creatorcontrib>Gaudet, John G.</creatorcontrib><creatorcontrib>Connolly, E. Sander</creatorcontrib><title>Impact of Cognitive Dysfunction on Survival in Patients With and Without Statin Use Following Carotid Endarterectomy</title><title>Neurosurgery</title><addtitle>Neurosurgery</addtitle><description>BACKGROUND:
Early cognitive dysfunction (eCD) is a subtle form of neurological injury observed in ∼25% of carotid endarterectomy (CEA) patients. Statin use is associated with a lower incidence of eCD in asymptomatic patients having CEA.
OBJECTIVE:
To determine whether eCD status is associated with worse long-term survival in patients taking and not taking statins.
METHODS:
This is a post hoc analysis of a prospective observational study of 585 CEA patients. Patients were evaluated with a battery of neuropsychometric tests before and after surgery. Survival was compared for patients with and without eCD stratifying by statin use. At enrollment, 366 patients were on statins and 219 were not. Survival was assessed by using Kaplan-Meier methods and multivariable Cox proportional hazards models.
RESULTS:
Age ≥75 years (P = .003), diabetes mellitus (P < .001), cardiac disease (P = .02), and statin use (P = .014) are significantly associated with survival univariately (P < .05) by use of the log-rank test. By Cox proportional hazards model, eCD status and survival adjusting for univariate factors within statin and nonstatin use groups suggested a significant effect by association of eCD on survival within patients not taking statin (hazard ratio, 1.61; 95% confidence interval, 1.09–2.40; P = .018), and no significant effect of eCD on survival within patients taking statin (hazard ratio, 0.98; 95% confidence interval, 0.59–1.66; P = .95).
CONCLUSION:
eCD is associated with shorter survival in patients not taking statins. This finding validates eCD as an important neurological outcome and suggests that eCD is a surrogate measure for overall health, comorbidity, and vulnerability to neurological insult.</description><subject>Aged</subject><subject>Carotid Stenosis - mortality</subject><subject>Carotid Stenosis - psychology</subject><subject>Carotid Stenosis - surgery</subject><subject>Cognition Disorders - epidemiology</subject><subject>Comorbidity</subject><subject>Confidence intervals</subject><subject>Endarterectomy, Carotid - adverse effects</subject><subject>Female</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neurosurgery</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Statins</subject><subject>Treatment Outcome</subject><issn>0148-396X</issn><issn>1524-4040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkd1rkzEYxYMork7_A5GAN7vplrz57KXUbg6GE2bRu5DmTdbM901qPlr635vZKbIbFwJ5IL9zODwHgLcYneKuE2efF8tT9O-ZIfoMTDDr6JQiip6DCcJUTsmMfz8Cr3K-QwhzKuRLcNRxgiQnbALK5bjRpsDo4DzeBl_81sKP--xqMMXHANu9qWnrt3qAPsAvungbSobffFlDHfrfQ6wF3pT2FeAyW3gehyHufLiFc51i8T1chF6nYpM1JY771-CF00O2bx7eY7A8X3ydf5peXV9czj9cTQ3tKL1PPiMrJrnTSDPCidNCY9MzbgWnCEu04pxogYxETmiLjJCISeskdRY5R47BycF3k-LPanNRo8_GDoMONtassCCMdG0ns4a-f4TexZpCS6c6wgTrGGayUfRAmRRzTtapTfKjTnuFkbpvRbVW1ONWmuzdg3ldjbb_K_pTQwPkAdjFoW0p_xjqzia1tnoo6_95nx2ksW6eluYXClumXQ</recordid><startdate>20151201</startdate><enddate>20151201</enddate><creator>Heyer, Eric J.</creator><creator>Mergeche, Joanna L.</creator><creator>Wang, Shuang</creator><creator>Gaudet, John G.</creator><creator>Connolly, E. Sander</creator><general>Oxford University Press</general><general>Copyright by the Congress of Neurological Surgeons</general><general>Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20151201</creationdate><title>Impact of Cognitive Dysfunction on Survival in Patients With and Without Statin Use Following Carotid Endarterectomy</title><author>Heyer, Eric J. ; Mergeche, Joanna L. ; Wang, Shuang ; Gaudet, John G. ; Connolly, E. Sander</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4244-39693b586fa0a5363fa7a1cd56e7640180b663a70c80f7ae0c78058ef84fe0ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Carotid Stenosis - mortality</topic><topic>Carotid Stenosis - psychology</topic><topic>Carotid Stenosis - surgery</topic><topic>Cognition Disorders - epidemiology</topic><topic>Comorbidity</topic><topic>Confidence intervals</topic><topic>Endarterectomy, Carotid - adverse effects</topic><topic>Female</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neurosurgery</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Statins</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Heyer, Eric J.</creatorcontrib><creatorcontrib>Mergeche, Joanna L.</creatorcontrib><creatorcontrib>Wang, Shuang</creatorcontrib><creatorcontrib>Gaudet, John G.</creatorcontrib><creatorcontrib>Connolly, E. Sander</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heyer, Eric J.</au><au>Mergeche, Joanna L.</au><au>Wang, Shuang</au><au>Gaudet, John G.</au><au>Connolly, E. Sander</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Cognitive Dysfunction on Survival in Patients With and Without Statin Use Following Carotid Endarterectomy</atitle><jtitle>Neurosurgery</jtitle><addtitle>Neurosurgery</addtitle><date>2015-12-01</date><risdate>2015</risdate><volume>77</volume><issue>6</issue><spage>880</spage><epage>887</epage><pages>880-887</pages><issn>0148-396X</issn><eissn>1524-4040</eissn><abstract>BACKGROUND:
Early cognitive dysfunction (eCD) is a subtle form of neurological injury observed in ∼25% of carotid endarterectomy (CEA) patients. Statin use is associated with a lower incidence of eCD in asymptomatic patients having CEA.
OBJECTIVE:
To determine whether eCD status is associated with worse long-term survival in patients taking and not taking statins.
METHODS:
This is a post hoc analysis of a prospective observational study of 585 CEA patients. Patients were evaluated with a battery of neuropsychometric tests before and after surgery. Survival was compared for patients with and without eCD stratifying by statin use. At enrollment, 366 patients were on statins and 219 were not. Survival was assessed by using Kaplan-Meier methods and multivariable Cox proportional hazards models.
RESULTS:
Age ≥75 years (P = .003), diabetes mellitus (P < .001), cardiac disease (P = .02), and statin use (P = .014) are significantly associated with survival univariately (P < .05) by use of the log-rank test. By Cox proportional hazards model, eCD status and survival adjusting for univariate factors within statin and nonstatin use groups suggested a significant effect by association of eCD on survival within patients not taking statin (hazard ratio, 1.61; 95% confidence interval, 1.09–2.40; P = .018), and no significant effect of eCD on survival within patients taking statin (hazard ratio, 0.98; 95% confidence interval, 0.59–1.66; P = .95).
CONCLUSION:
eCD is associated with shorter survival in patients not taking statins. This finding validates eCD as an important neurological outcome and suggests that eCD is a surrogate measure for overall health, comorbidity, and vulnerability to neurological insult.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>26308635</pmid><doi>10.1227/NEU.0000000000000904</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Carotid Stenosis - mortality Carotid Stenosis - psychology Carotid Stenosis - surgery Cognition Disorders - epidemiology Comorbidity Confidence intervals Endarterectomy, Carotid - adverse effects Female Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Incidence Male Middle Aged Neurosurgery Proportional Hazards Models Prospective Studies Risk Factors Statins Treatment Outcome |
| title | Impact of Cognitive Dysfunction on Survival in Patients With and Without Statin Use Following Carotid Endarterectomy |
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