Abstract 214: Risk and Risk Factors of Perioperative Myocardial Infarction After Carotid Endarterectomy and Carotid Angioplasty and Stenting: Systematic Review and Meta-analysis

Abstract

Background and purpose: Carotid Angioplasty and Stenting (CAS) is associated with higher risk of periprocedural stroke and death compared with carotid endarterectomy (CEA). By contrast, the risk of myocardial infarction (MI) was higher after CEA than after CAS in randomized trials. However, numbers were small and risk factors are unknown. We therefore aimed to estimate the 30-day absolute risk of periprocedural MI after CAS and CEA and to determine which subgroups are at higher risks. Methods: We performed a systematic review and a meta-analysis of studies published from 01/1980 to 06/2014 and also collected unpublished data. We selected observational and randomized studies with data available on MI in at least one subgroup. We calculated pooled absolute and relative risks and identified differential effects on risks of MI (CAS vs CEA) with interaction tests using meta-regressions. Results: The 30-day absolute risk of MI after CEA was 0.82% (95%CI, 0.67-0.99; 66 studies, 75191 patients) and 0.64% (95%CI, 0.50-0.79; 76 studies, 40431 patients) after CAS (Pint=0.08). Risk of MI has slightly decreased over time in CAS studies but has not changed in CEA studies (Pint=0.14). After CAS, patients with symptomatic stenosis, restenosis were at higher risk of MI whereas males were at lower risk (figure). After CEA, age, history of coronary artery disease, peripheral artery disease, and restenosis increased the risk of MI. Only the effect of gender differed between CAS and CEA with males being at lower risk of MI than females after CAS whereas there was no difference between after CEA (Pint=0.01). Conclusion: The risk of MI is slightly higher after CEA than after CAS. Risk factors for periprocedural MI are overall very similar in both techniques except that males are at lower risk of MI after CAS but not after CEA (p int=0.01).