Homocysteine Improves Risk Stratification in Patients Undergoing Endarterectomy for Asymptomatic Internal Carotid Artery Stenosis

Background and Purpose—A limited life expectancy reduces the benefit from carotid endarterectomy (CEA) for treatment of asymptomatic internal carotid artery stenosis. The aim of this study was to assess homocysteine as stratifying biomarker to improve prediction of postoperative survival. Methods—This was a single-center cohort study from 2003 to 2012. Two hundred and fourteen consecutive patients (<75 years, n=130; ≥75 years, n=84) undergoing CEA for their asymptomatic internal carotid artery stenosis were observed for 8.5 years for the occurrence of death after CEA as primary end point (EC-nr: 04-067-0604). Homocysteine and major cardiovascular risk factors were used for computation of prognostic indices. Cumulative survival of prognostic indices–based quintiles was estimated by Kaplan–Meier curves. Results—Total homocysteine had a significant effect on postoperative survival (P<0.0001). Total homocysteine–based quintiles of prognostic indices showed a better prediction of the survival of the patients t...