Role of risk scoring systems in predicting life expectancy after carotid endarterectomy in asymptomatic patients

Objective: The aim of this study is to compare and to test the performance of all available risk scoring systems (RSSs)<br> designed to predict long-term survival rate in asymptomatic candidate patients for carotid endarterectomy (CEA) for<br> significant carotid artery stenosis.<br> Methods: Data on asymptomatic patients who underwent CEA in three high-volume centers were prospectively<br> recorded. Through literature research using Preferred Reporting Items for Systematic Reviews and Meta-Analyses<br> (PRISMA) recommendations, six RSSs were identified for the intent of the study. Primary endpoints were 3- and<br> 5-year survival rates after CEA. All items used as variables to compose multiple RSSs were applied to every patient<br> in the study population. The 3- and 5-year mortality prediction rates for each score were assessed by sensitivity,<br> specificity, and predictive negative and positive value calculation, as well as univariable Cox proportional hazard<br> models with the Harrell C index.<br> Results: During the study period, 825 CEAs in 825 asymptomatic patients were analyzed. All items used in RSSs were<br> available in the dataset, with some concerns regarding their definition and application among RSSs. The 3- and 5-year<br> survival rates of the study cohort were 94.5% and 90.3%, respectively. Among the six RSSs analyzed, no RSS demonstrated<br> optimal results in terms of mortality rate prediction accuracy, although some scores had good diagnostic and risk<br> of death precision.<br> Conclusion: RSSs, when used alone, fail to optimally detect postoperative life expectancy in asymptomatic CEA patient<br> candidates. Further prospective controlled studies are needed to compose and validate RSSs with better calibration to<br> predict outcomes.