b'Scientific Session Abstracts SUNDAY APRIL 21, 202436: POSTOPERATIVE STROKE AND MYOCARDIAL INFARCTION IMPACT ON ONE-YEAR MORTALITY FOLLOWING CAROTID REVASCULARIZATIONAhmed Abdelkarim 1 , MD; Mohammed Hamouda 1 , MD,Mohamed Abdalla 1 , MD, Sina Zarrintan 1MD, MPH, Jesse A Columbo 2 , MD, Mahmoud B. Malas 1 , MD, MHS, FACS, RPVI1Department of Surgery, Division of Vascular and Endovascular Surgery, UC San Diego (UCSD), San Diego, California.2Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.Objective: Postoperative stroke and MI are associated with devastating postoperative morbidity and mortality, therefore limiting the protective effect of carotid revascularization procedures. Moreover, there seems to be a relation between the severity of stroke and MI and the type of carotid revascularization technique. We aim to investigate the impact of in-hospital stroke or MI on one-year mortality following Carotid Endarterectomy (CEA), Transfemoral Carotid Artery Stenting (TFCAS), and Transcarotid Artery Revascularization (TCAR).Methods: This is a retrospective analysis of patients undergoing CEA, TFCAS, and TCAR in the VQI database (20162023). Our primary outcome is one-year mortality in patients who developed in-hospital stroke or MI following carotid revascularization. Kaplan-Meier survival estimate, and Multivariable Cox regression analysis were applied to calculate Hazard ratios (HR) after adjusting for potential confounders.Results: Our study included 125,657(62%) CEA, 25,529(12.6%) TFCAS, and 51,567(25.4%) TCAR. The hazards of 1-year mortality after in-hospital stroke were higher following CEA (aHR = 5.9[95%CI:5.1-6.8] P0.001), TFCAS (aHR=4.2[95%CI:3.7-5.3] P0.001), and TCAR (aHR=5.2[95%CI:4.1-6.5] P0.001). The hazards of 1-year mortality after in-hospital MI were also higher following CEA (aHR=3.8[95%CI:3.1-4.6] P0.001), TFCAS (aHR=3.5[95%CI:2.3-5.5] P0.001), and TCAR (aHR=5.1[95%CI:3.6-7.2] P0.001)(Table). This trend persisted in sub-analysis based on symptomatic status. At 1-year, TFCAS showed the lowest survival following in- hospital stroke or MI. Among patients who developed in-hospital stroke, there was nosignificant difference in one-year mortality between TCAR and CEA (aHR=0.93[95%CI:0.73-1.2] P=0.55). On the other hand, TFCAS was associated with a 50% higher hazard than CEA (aHR=1.5[95%CI:1.1-2.1] P=0.003). TCAR was associated with 30% reduction in this hazard compared to TFCAS (aHR=0.7[95%CI:0.55-0.94] P=0.015) (Table). Among patients whodeveloped in-hospital MI, no significant difference was found between TCAR and CEA. However, TFCAS was associated with more than double the hazard of 1-year mortality compared to CEA (aHR=2.3[95%CI:1.2-4.2] P=0.007).42 NDANNUAL MEETING|APRIL 1921, 2024|OCEANSIDE, CA 91'