Impact of heart failure on the in-hospital outcomes after carotid artery stenting and carotid endarterectomy

Abstract

Objectives: We evaluated in-hospital outcomes among patients with heart failure (HF) undergoing carotid revascularization. Methods: Using the National Inpatient Sample (2016-2022), we identified patients with carotid artery stenosis who underwent carotid artery stenting (CAS) or carotid endarterectomy (CEA). Based on HF status, we compared in-hospital mortality, cerebral infarction, hemorrhage, discharge disposition, length of stay, and hospitalization cost. Results: Among 39,750 patients, 5,635 (14.2%) had HF: systolic HF in 1,900 (33.7%), diastolic HF in 2,035 (36.1%), combined systolic-diastolic HF in 555 (9.8%), and unspecified HF in 1,145 (20.3%). Rates of acute myocardial infarction, respiratory failure, septic shock, acute renal insufficiency, required intubation, and blood transfusion were higher in HF patients undergoing both CAS and CEA. After adjustment, there was a numerically higher but statistically non-significant rate of in-hospital mortality in HF patients treated with CAS (odds ratio [OR] 1.46, 95% confidence interval [CI] 0.96-2.23, p = 0.075) and CEA (OR 1.60, 95% CI 0.93-2.74, p = 0.09). Among CAS patients, combined systolic-diastolic HF carried the highest risk for in-hospital mortality (OR 4.41, 95% CI 2.06-9.43; p < 0.001), with numerically higher but non-significant associations among CEA patients. Conclusion: HF was present in one of seven patients undergoing carotid revascularization and remains a significant determinant of perioperative outcomes and resource utilization. Combined systolic-diastolic HF was associated with longer hospital stay and higher resource utilization.