Constructing an Assessment Model for Outcome after Carotid Stent Using National Health Insurance Database with Validation by Clinical Data

About 70 million people occurred stroke each year in the United States, ischemic stroke accounts about 80%. The cost of stroke care in the United States each year takes nearly 40 billion every month, it spend 1.5-4 million in Taiwan. It causes patients and their families psychologically and economic problem. We will check medical records, age, gender, stroke risk factors (diabetes, hypertension, heart disease, smoking, drinking, hypercholesterolemia) variables. Carotid stenosis accounts for about 2%, the annual risk of stroke of approximately 1-2%. Neck carotid ultrasound is fast, secure and convenient way to check vessel condition, it can detect carotid artery stenosis and help us to decide whether the planned carotid endarterecctomy or carotid artery stenting. Nation Health Insurance Research Database (NHIRD) with long term follow-up database, we will use the data of carotid stent patients. The outcome detected with mortality, stroke and coronary artery disease after stenting. We will use cox regression to detect hazard ratio and develop risk model of carotid stenosis. We construct a nomogram with total points to predict probability of main cardiac events and patients were categorized into low, median and high risk. Meanwhile, Artificial Neural Network is also applied to construct another assessment model. These models created from NHIRD will be validated by the clinical data of a medical center. According to the risk classification, outcome of carotid stent was provided clinical data in Taiwan and evidence to discuss with patient and family.