{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:35:32Z","timestamp":1791380132811,"version":"4.3.3"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2011,6,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) found a higher risk of stroke after carotid artery stenting and a higher risk of myocardial infarction (MI) after carotid endarterectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      Cardiac biomarkers and ECGs were performed before and 6 to 8 hours after either procedure and if there was clinical evidence of ischemia. In CREST, MI was defined as biomarker elevation plus either chest pain or ECG evidence of ischemia. An additional category of biomarker elevation with neither chest pain nor ECG abnormality was prespecified (biomarker+ only). Crude mortality and risk-adjusted mortality for MI and biomarker+ only were assessed during follow-up. Among 2502 patients, 14 MIs occurred in carotid artery stenting and 28 MIs in carotid endarterectomy (hazard ratio, 0.50; 95% confidence interval, 0.26 to 0.94;\n                      <jats:italic>P<\/jats:italic>\n                      =0.032) with a median biomarker ratio of 40 times the upper limit of normal. An additional 8 carotid artery stenting and 12 carotid endarterectomy patients had biomarker+ only (hazard ratio, 0.66; 95% confidence interval, 0.27 to 1.61;\n                      <jats:italic>P<\/jats:italic>\n                      =0.36), and their median biomarker ratio was 14 times the upper limit of normal. Compared with patients without biomarker elevation, mortality was higher over 4 years for those with MI (hazard ratio, 3.40; 95% confidence interval, 1.67 to 6.92) or biomarker+ only (hazard ratio, 3.57; 95% confidence interval, 1.46 to 8.68). After adjustment for baseline risk factors, both MI and biomarker+ only remained independently associated with increased mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>In patients randomized to carotid endarterectomy versus carotid artery stenting, both MI and biomarker+ only were more common with carotid endarterectomy. Although the levels of biomarker elevation were modest, both events were independently associated with increased future mortality and remain an important consideration in choosing the mode of carotid revascularization or medical therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.ClinicalTrials.gov\">http:\/\/www.ClinicalTrials.gov<\/jats:ext-link>\n                      . Unique identifier: NCT00004732.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.110.008250","type":"journal-article","created":{"date-parts":[[2011,5,24]],"date-time":"2011-05-24T00:44:58Z","timestamp":1306197898000},"page":"2571-2578","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":176,"title":["Myocardial Infarction After Carotid Stenting and Endarterectomy"],"prefix":"10.1161","volume":"123","author":[{"given":"Joseph L.","family":"Blackshear","sequence":"first","affiliation":[{"name":"From the Mayo Clinic, Jacksonville, FL (J.L.B., T.G.B.); Beth Israel Deaconess Medical Center, Harvard Clinical Research Institute, Boston, MA (D.E.C.); Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Saint Luke's MidAmerica Heart and Vascular Institute, Kansas City, MO (D..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald E.","family":"Cutlip","sequence":"additional","affiliation":[{"name":"From the Mayo Clinic, Jacksonville, FL (J.L.B., T.G.B.); Beth Israel Deaconess Medical Center, Harvard Clinical Research Institute, Boston, MA (D.E.C.); Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Saint Luke's MidAmerica Heart and Vascular Institute, Kansas City, MO (D..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary S.","family":"Roubin","sequence":"additional","affiliation":[{"name":"From the Mayo Clinic, Jacksonville, FL (J.L.B., T.G.B.); Beth Israel Deaconess Medical Center, Harvard Clinical Research Institute, Boston, MA (D.E.C.); Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Saint Luke's MidAmerica Heart and Vascular Institute, Kansas City, MO (D..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Hill","sequence":"additional","affiliation":[{"name":"From the Mayo Clinic, Jacksonville, FL (J.L.B., T.G.B.); Beth Israel Deaconess Medical Center, Harvard Clinical Research Institute, Boston, MA (D.E.C.); Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Saint Luke's MidAmerica Heart and Vascular Institute, Kansas City, MO (D..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre P.","family":"Leimgruber","sequence":"additional","affiliation":[{"name":"From the Mayo Clinic, Jacksonville, FL (J.L.B., T.G.B.); Beth Israel Deaconess Medical Center, Harvard Clinical Research Institute, Boston, MA (D.E.C.); Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Saint Luke's MidAmerica Heart and Vascular Institute, Kansas City, MO (D..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Begg","sequence":"additional","affiliation":[{"name":"From the Mayo Clinic, Jacksonville, FL (J.L.B., T.G.B.); Beth Israel Deaconess Medical Center, Harvard Clinical Research Institute, Boston, MA (D.E.C.); Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Saint Luke's MidAmerica Heart and Vascular Institute, Kansas City, MO (D..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Cohen","sequence":"additional","affiliation":[{"name":"From the Mayo Clinic, Jacksonville, FL (J.L.B., T.G.B.); Beth Israel Deaconess Medical Center, Harvard Clinical Research Institute, Boston, MA (D.E.C.); Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Saint Luke's MidAmerica Heart and Vascular Institute, Kansas City, MO (D..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F.","family":"Eidt","sequence":"additional","affiliation":[{"name":"From the Mayo Clinic, Jacksonville, FL (J.L.B., T.G.B.); Beth Israel Deaconess Medical Center, Harvard Clinical Research Institute, Boston, MA (D.E.C.); Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Saint Luke's MidAmerica Heart and Vascular Institute, Kansas City, MO (D..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig R.","family":"Narins","sequence":"additional","affiliation":[{"name":"From the Mayo Clinic, Jacksonville, FL (J.L.B., T.G.B.); Beth Israel Deaconess Medical Center, Harvard Clinical Research Institute, Boston, MA (D.E.C.); Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Saint Luke's MidAmerica Heart and Vascular Institute, Kansas City, MO (D..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald J.","family":"Prineas","sequence":"additional","affiliation":[{"name":"From the Mayo Clinic, Jacksonville, FL (J.L.B., T.G.B.); Beth Israel Deaconess Medical Center, Harvard Clinical Research Institute, Boston, MA (D.E.C.); Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Saint Luke's MidAmerica Heart and Vascular Institute, Kansas City, MO (D..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Glasser","sequence":"additional","affiliation":[{"name":"From the Mayo Clinic, Jacksonville, FL (J.L.B., T.G.B.); Beth Israel Deaconess Medical Center, Harvard Clinical Research Institute, Boston, MA (D.E.C.); Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); 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Lenox Hill Hospital, New York, NY (G.S.R.); University of Calgary, Calgary Stroke Program, Foothills Hospital, Calgary, AB, Canada (M.D.H.); Providence Spokane Heart Institute, Spokane, WA (P.P.L.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Saint Luke's MidAmerica Heart and Vascular Institute, Kansas City, MO (D..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the CREST Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0912321"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe1005220"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000036016.52396.bb"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.05.001"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2004.00463.x"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi430"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm620"},{"key":"e_1_3_3_9_2","first-page":"19","article-title":"Does the use of a volatile anesthetic regimen attenuate the incidence of cardiac events after vascular surgery?","volume":"59","author":"DeHert SG","year":"2008","unstructured":"DeHert SG, Longrois D, Yang H, Fleisher LA. 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