The Gupta Perioperative Risk for Myocardial Infarct or Cardiac Arrest (MICA) Calculator as an Intraoperative Neurologic Deficit Predictor in Carotid Endarterectomy

Data de publicação: 01/11/2022

Autores da FMUP

• António Henrique Pereira Neves

  Autor

• Joana Irene De Barros Mourão

  Autor

• José Paulo Alves Vieira De Andrade

  Autor

• João Manuel Palmeira Rocha Neves

  Autor

Participantes de fora da FMUP

• Pereira Macedo, J
• Lopes Fernandes, B
• Duarte Gamas, L
• Khairy, A
• Marreiros, A

Unidades de investigação

• Biomedicina

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Background: Patients undergoing carotid endarterectomy (CEA) may experiment intraoperative neurologic deficits (IND) during carotid cross-clamping. This work aimed to assess the impact of the Gupta Perioperative Myocardial Infarct or Cardiac Arrest (MICA) risk calculator in the IND. Methods: From January 2012 to April 2021, patients undergoing CEA with regional anaesthesia for carotid stenosis with IND and consecutively control operated patients without IND were selected. A regressive predictive model was created, and a receiver operating characteristic (ROC) curve was applied for comparison. A multivariable dependence analysis was conducted using a classification and regression tree (CRT) algorithm. Results: A total of 97 out of 194 included patients developed IND. Obesity showed aOR = 4.01 (95% CI: 1.66-9.67) and MICA score aOR = 1.21 (1.03-1.43). Higher contralateral stenosis showed aOR = 1.29 (1.08-1.53). The AUROC curve was 0.656. The CRT algorithm differentiated obese patients with a MICA score >= 8. Regarding non-obese patients, the model identified the presence of contralateral stenosis >= 55% with a MICA >= 10. Conclusion: MICA score might play an additional role in stratifying patients for IND in CEA. Obesity was determined as the best discrimination factor, followed by a score >= 8. A higher ipsilateral stenosis degree is suggested to have a part in avoiding procedure-related IND. Larger studies might validate the benefit of MICA score regarding the risk of IND.

Keywords

• carotid endarterectomy; carotid stenosis; major adverse cardiovascular events; survival analysis; MICA score; atherosclerosis; perioperative stroke