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Periprocedural Myocardial Infarction After Carotid Endarterectomy and Stenting: Systematic Review and Meta-Analysis

Marion Boulanger1, Lucie Camelière1, Rui Felgueiras1

  • 1From the Service de Neurologie (M.B., E.T.), and Service de Chirurgie Vasculaire (L.C., L.B.), CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France; Neurology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal (R.F.); Department of Surgery, Faculty of Medicine and Research Institute for Health Science, Chiang Mai University, Chiang Mai, Thailand (K.R.); Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and INSERM UMR U919, Caen, France (E.T.).

Stroke
|August 20, 2015
PubMed

Insights

The risk of myocardial infarction (MI) after carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) is similar. Risk factors for MI also largely overlap between CEA and CAS, with a notable exception in the effect of sex.

Area of Science:

  • Cardiovascular medicine
  • Interventional cardiology
  • Vascular surgery

Background:

  • Carotid angioplasty and stenting (CAS) carries a higher risk of stroke and death than carotid endarterectomy (CEA).
  • Randomized trials suggest a higher risk of myocardial infarction (MI) after CEA compared to CAS, but numbers were small and risk factors remain unclear.

Purpose of the Study:

  • To systematically review and meta-analyze the risk of MI after CAS and CEA.
  • To identify and compare risk factors for MI in patients undergoing CAS versus CEA.

Main Methods:

  • Systematic review and meta-analysis of studies from January 1980 to June 2014, including unpublished data.
  • Extracted data on 9 predefined risk factors and analyzed absolute and relative risks of MI.
  • Identified differential effects of risk factors on MI between CAS and CEA.

Main Results:

  • The 30-day absolute risk of MI was 0.87% after CEA and 0.70% after CAS (P=0.38).
  • Symptomatic stenosis, restenosis, and male sex were associated with higher MI risk after CAS.
  • Age, coronary artery disease, peripheral artery disease, and restenosis increased MI risk after CEA.
  • Men had a lower risk of MI after CAS compared to women, a difference not observed after CEA (P=0.01).

Conclusions:

  • The overall risk of MI is not significantly different between CAS and CEA.
  • Risk factors for MI are generally similar for both procedures.
  • Men exhibit a lower risk of MI following CAS but not CEA.
Abstract

Keywords:
atherosclerosiscarotid stenosisendarterectomy, carotidmeta-analysismyocardial infarctionreview, systematic

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