Outcome of Carotid Artery Endarterectomy in Statin Users versus Statin-Naïve Patients: A Systematic Review and Meta-Analysis

Abstract

Carotid artery endarterectomy (CEA) remains the most common surgical intervention for the treatment of symptomatic and asymptomatic carotid artery stenosis. Several studies have shown a lower risk of periprocedural adverse events in statin users who undergo coronary interventions or carotid artery stenting. The aim of this meta-analysis was to determine whether the use of statins is beneficial in patients undergoing CEA. This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were identified through a search of PubMed, Scopus, and Cochrane until August 2017. A random effects model meta-analysis was conducted and the I2 statistic was used to assess for heterogeneity. Six studies and 7053 patients overall were included. Thirty days after CEA, 157 (2.2%) patients had a stroke (1.4% in the statin-user group vs. 3% in the statin-naïve group). Despite the difference in the absolute rate of stroke, there was no statistically significant difference in the 30-day stroke rate (odds ratio [OR] 0.40; 95% confidence interval [CI] 0.15-1.09; I2= 75.6%). Overall, 141 (2%) patients suffered 30-day myocardial infarction, with no significant difference between the 2 groups (OR 0.77; 95% CI 0.26-2.24; I2= 77%). Patients who received statins before CEA were at a significantly lower risk for 30-day death (OR 0.26; 95% CI 0.10-0.61; I2= 17.7%). Statin users undergoing CEA were at a significantly lower risk for periprocedural death compared with statin-naïve patients. Despite an absolute difference in the stroke rate, the current meta-analysis did not detect a statistically significant difference in the 30-day stroke rate between statin-user and statin-naïve patients undergoing CEA.