Abstract TP128: Occurrence and Short-term Outcomes of Heart Failure in Patients Undergoing Carotid Artery Stenting and Carotid Endarterectomy in the United States

Background: Patients with heart failure were excluded from the trials evaluating carotid artery stent placement (CAS) or carotid endarterectomy (CEA). We identified the prevalence of heart failure and associations with outcomes in patients with symptomatic internal carotid artery (ICA) stenosis undergoing CAS or CEA. Methods: We analyzed the data from the National Inpatient Sample between 2016 and 2022 with stenosis of ICA who underwent CAS or CEA. We compared the end points of intra- and post-procedural cerebral infarction, hemorrhage, discharge home and death based on the presence or absence of heart failure. Results: Heart failure was present in 5,635 (14.2%) of 39,750 patients who underwent either CAS or CEA between 2016 and 2022. Within the heat failure group, 1,900 (33.7%) had systolic heart failure, 2,035 (36.1%) had diastolic HF, 555 (9.8%) had combined systolic and diastolic heart failure, and 1,145 (20.3%) had unspecified HF subtypes. The proportion of patients who developed acute myocardial infarction, respiratory failure, required intubation, septic shock, acute kidney injury, or required blood transfusion was higher in patients with heart failure among both CAS- and CEA-treated patients. There was a trend towards higher odds of in-hospital mortality in patients with heart failure (compared with those without heart failure) who were treated with CAS (odds ratio [OR] 1.46, 95% confidence interval [CI] 0.96-2.23, p = 0.075) and those treated with CEA (OR 1.60, 95% CI 0.93-2.74, p = 0.0.090) after adjusting for potential confounders. The length of stay and hospitalization cost were significantly higher in patients with heart failure accompanied by lower odds of discharge to home. Among patients undergoing CAS, those with combined systolic and diastolic heart failure had higher risk for in-hospital mortality (OR 4.41, 95% CI 2.06-9.43; p < 0.001), similar trends were observed in patients undergoing CEA. Conclusion: Approximately 14% of patients with symptomatic ICA stenosis undergo CAS or CEA have concurrent heart failure. CEA or CAS in patients with heart failure was associated with resource utilization. Patients with combined systolic and diastolic heart failure had higher odds of in-hospital mortality with CAS or CEA.