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Carotid endarterectomy (CEA) risk stratification for adverse events at one year follow-up: the role of preoperative functional capacity scores, age, BNP and hemoglobin

  • Paolo M. Angeletti1
  • Chiara Angeletti2,*,
  • Antonella Mattei3
  • Francesca Caniglia4
  • Francesca De Sanctis5
  • Fabrizia Biocca6
  • Davide Fionda7
  • Alessandra Ciccozzi8
  • Franco Marinangeli8

1Operative unit of Cardiothoracic Anesthesiology and Intensive Care, Civil Hospital G. Mazzini of Teramo, 64100 Teramo, Italy

2Anesthesiology, Intensive Care and Pain Medicine, Civil Hospital G. Mazzini of Teramo, 64100 Teramo, Italy

3Department of Life, Health and Environmental Sciences, Epidemiology and Biostatistics Unit, University of L’Aquila, 67100 L’Aquila, Italy

4Operative Unit of Anesthesia and Intensive Care Unit of Madonna delle Grazie Hospital,75100 Matera, Italy

5Anesthesia and Intensive Care Unit of S. Maria Hospital of Terni, 05100 Terni, Italy

6Anesthesia and Intensive Care Unit of SS Filippo e Nicola Hospital of Avezzano, 67051 Avezzano, Italy

7Anesthesia and Intensive Care Unit of SS Annunziata Hospital of Sulmona, 67039 Sulmona, Italy

8Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy

DOI: 10.22514/sv.2023.045 Vol.19,Issue 4,July 2023 pp.119-128

Submitted: 21 June 2022 Accepted: 18 October 2022

Published: 08 July 2023

*Corresponding Author(s): Chiara Angeletti E-mail:;


The aim of the study was to evaluate combination of functional status tools (American Society of Anesthesiologists Physical Status Classification System (ASA PS)) status, Metabolic Equivalent of Task (METs), Revised Cardiac Risk Index for Pre-Operative Risk (RCRI) largely used in preoperative risk assessment with humoral variables in building powerful predictive models of Major Adverse Cardiac Cerebrovascular Events (MACCE) in a one-year follow-up after carotid endoarterectomy (CEA). All consecutive patients undergoing CEA during a 12-month period, were enrolled in this prospective observational study. Demographic data, functional capacity (FC) measured by risk stratification scores RCRI, ASA physical status, METs and preoperative levels of hemoglobin and Brain Natriuretic Peptide (Pro-BNP), coexisting comorbidities, have been collected. 201 consecutive patients undergoing CEA under local anesthesia (men 137 (68.16%), women 64 (31.84%)) with a median age of 75 years (Interquartile range (IQR) 67–80 years), Body mass index (BMI) median of 26.23 (IQR 24.4–28.89) were enrolled. Combination of all variables studied leave at a good one-year prognostic tool with AUC of 0.93 (Sensitivity (SEN) 46.6, Specificity (SPEC) 95.7). Preoperative hemoglobin correlate with Major Adverse Cardiac Cerebrovascular Events (MACCE) at 3 months (p = 0.018), while the preoperative BNP at 12 months shows correlation with adverse events (p = 0.004). Age has a significant correlation with adverse events at 12 months between demographic and anthropometric factors (p = 0.002). MACCE may adversely affect short- and long-term outcomes after CEA. Evaluation of preoperative functional capacity by RCRI, ASA physical status and METs combined with age and biomarkers such as pro-BNP and hemoglobin, may improve risk stratification in patients undergoing carotid surgery.


Carotid endoarterectomy (CEA); Major adverse cardiac cerebrovascular events (MACCE); BNP; RCRI; Hemoglobin; ASA PS; METs; Risk evaluation

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Paolo M. Angeletti,Chiara Angeletti,Antonella Mattei,Francesca Caniglia,Francesca De Sanctis,Fabrizia Biocca,Davide Fionda,Alessandra Ciccozzi,Franco Marinangeli. Carotid endarterectomy (CEA) risk stratification for adverse events at one year follow-up: the role of preoperative functional capacity scores, age, BNP and hemoglobin. Signa Vitae. 2023. 19(4);119-128.


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