Risk Factors of Cerebral Infarction and Myocardial Infarction after Carotid Endarterectomy Analyzed by Machine Learning

Objective The incidence of cerebral infarction and myocardial infarction is higher in patients with carotid endarterectomy (CEA). Based on the concept of coprotection of heart and brain, this study attempts to screen the related factors of early cerebral infarction and myocardial infarction after CEA with the method of machine learning to provide clinical data for the prevention of postoperative cerebral infarction and myocardial infarction. Methods 443 patients who received CEA operation under general anesthesia within 2 years were collected as the research objects. The demographic data, previous medical history, degree of neck vascular stenosis, blood pressure at all time points during the perioperative period, the time of occlusion, whether to place the shunt, and the time of hospital stay, whether to have cerebral infarction and myocardial infarction were collected. The machine learning model was established, and stable variables were selected based on single-factor analysis. Results The incidence of cerebral infarction was 1.4% (6/443) and that of myocardial infarction was 2.3% (10/443). The hospitalization time of patients with cerebral infarction and myocardial infarction was longer than that of the control group (8 (7, 15) days vs. 7 (5, 8) days, P = 0.002). The stable related factors were screened out by the xgboost model. The importance score (F score) was as follows: average arterial pressure during occlusion was 222 points, body mass index was 159 points, average arterial pressure postoperation was 156 points, the standard deviation of systolic pressure during occlusion was 153 points, diastolic pressure during occlusion was 146 points, mean arterial pressure after entry was 143 points, systolic pressure during occlusion was 121 points, and age was 117 points. Conclusion Eight factors, such as blood pressure, body mass index, and age, may be related to the postoperative cerebral infarction and myocardial infarction in patients with CEA. The machine learning method deserves further study.

[1]  A. Garg,et al.  Relationship between Intraoperative Mean Arterial Pressure and Clinical Outcomes after Noncardiac Surgery: Toward an Empirical Definition of Hypotension , 2013, Anesthesiology.

[2]  K. Borgwardt,et al.  Machine Learning in Medicine , 2015, Mach. Learn. under Resour. Constraints Vol. 3.

[3]  A. Kuehnl,et al.  Intraoperative Completion Studies, Local Anesthesia, and Antiplatelet Medication Are Associated With Lower Risk in Carotid Endarterectomy , 2017, Stroke.

[4]  M. Schermerhorn,et al.  Stroke and death after carotid endarterectomy and carotid artery stenting with and without high risk criteria. , 2010, Journal of vascular surgery.

[5]  Xiaodan Ye,et al.  Predicting malignancy of pulmonary ground-glass nodules and their invasiveness by random forest. , 2018, Journal of thoracic disease.

[6]  P. Rothwell,et al.  Periprocedural Myocardial Infarction After Carotid Endarterectomy and Stenting: Systematic Review and Meta-Analysis , 2015, Stroke.

[7]  Tianqi Chen,et al.  XGBoost: A Scalable Tree Boosting System , 2016, KDD.

[8]  M. Bots,et al.  Clinical Prediction Rule to Estimate the Absolute 3-Year Risk of Major Cardiovascular Events After Carotid Endarterectomy , 2012, Stroke.

[9]  J. Eidt,et al.  Myocardial Infarction After Carotid Stenting and Endarterectomy: Results From the Carotid Revascularization Endarterectomy Versus Stenting Trial , 2011, Circulation.

[10]  R. Collins,et al.  Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies , 2009, The Lancet.

[11]  Y. Arbel,et al.  Prevalence and predictors of concomitant carotid and coronary artery atherosclerotic disease. , 2011, Journal of the American College of Cardiology.

[12]  J. Slattery,et al.  Clinical and angiographic predictors of stroke and death from carotid endarterectomy: systematic review , 1997, BMJ.

[13]  G. Stansby,et al.  Risk Factors For Stroke, Myocardial Infarction, or Death Following Carotid Endarterectomy: Results From the International Carotid Stenting Study , 2015, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[14]  L. Jiao,et al.  A study of carotid endarterectomy in a Chinese population: Initial experience at a single center , 2014, Clinical Neurology and Neurosurgery.

[15]  R. Collins,et al.  Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies , 2009, Lancet.

[16]  G. D. de Borst,et al.  Diastolic Blood Pressure is a Risk Factor for Peri-procedural Stroke Following Carotid Endarterectomy in Asymptomatic Patients , 2017, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[17]  J. Cigarroa,et al.  2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , 2016, The Journal of thoracic and cardiovascular surgery.

[18]  J. Freischlag,et al.  Class I obesity is paradoxically associated with decreased risk of postoperative stroke after carotid endarterectomy. , 2012, Journal of vascular surgery.

[19]  Dual Antiplatelet Therapy Does Not Increase the Risk of Bleeding After Carotid Endarterectomy: Results of a Prospective Study. , 2017, Annals of vascular surgery.

[20]  G. Howard,et al.  Carotid Endarterectomy and Carotid Artery Stenting in the US Medicare Population, 1999‐2014 , 2018 .

[21]  Gaël Varoquaux,et al.  Scikit-learn: Machine Learning in Python , 2011, J. Mach. Learn. Res..

[22]  Kei-Hoi Cheung,et al.  Predicting urinary tract infections in the emergency department with machine learning , 2018, PloS one.

[23]  T. Sarac,et al.  Characteristics that define high risk in carotid endarterectomy from the Vascular Study Group of New England. , 2015, Journal of vascular surgery.

[24]  I. R. Thomson,et al.  Haemodynamic instability and myocardial ischaemia during carotid endarterectomy: a comparison of propofol and isoflurane. , 1996, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[25]  Karla Kerlikowske,et al.  Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials , 2000, The Lancet.

[26]  V. Howard,et al.  Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis , 2016 .

[27]  A. Sidawy,et al.  Obesity is an independent risk factor for death and cardiac complications after carotid endarterectomy. , 2012, Journal of the American College of Surgeons.

[28]  M. Siebler,et al.  Detection of microembolic signals with transcranial Doppler ultrasound. , 2006, Frontiers of neurology and neuroscience.

[29]  T. Lindsay,et al.  Association between Intraoperative Hypotension and Myocardial Injury after Vascular Surgery , 2016, Anesthesiology.

[30]  P. T. Larsson,et al.  Carotid Atherosclerosis is Correlated with Extent and Severity of Coronary Artery Disease Evaluated by Myocardial Perfusion Scintigraphy , 2004, Angiology.

[31]  R. Pearse,et al.  A Prospective International Multicentre Cohort Study of Intraoperative Heart Rate and Systolic Blood Pressure and Myocardial Injury After Noncardiac Surgery: Results of the VISION Study , 2017, Anesthesia and analgesia.

[32]  G. LaMuraglia,et al.  Carotid Endarterectomy at the Millennium: What Interventional Therapy Must Match , 2004, Annals of surgery.