Statins are Associated with Better Outcomes After Carotid Endarterectomy in Symptomatic Patients

Abstract

Listen

Translate article

Conclusion: Statin therapy appears to have a protective effect in symptomatic patients undergoing carotid endarterectomy. Summary: Pleiotropic effects of statins are widely appreciated. Statins are associated with a reduction in mortality in non cardiac surgery. This study determined the effect of statin use at the time of hospital admission in patients undergoing carotid endarterectomy. The authors sought to determine whether statin use at the time of hospital admission in patients undergoing carotid endarterectomy was associated with a reduction of in-hospital adverse outcomes. All carotid endarterectomy cases were identified in four western Canadian provinces from January 2000 to December 2001. Charts were abstracted for data describing patient characteristics, surgical indication for endarterectomy, statin treatment, and in-hospital outcomes with respect to death, ischemic stroke, as well as cardiac outcomes. There were 3,360 patients included in the data base. Logistic regression analysis was used to compare outcomes of patients on statins versus those not on statins and to account for differences in patient characteristics. Propensity score analysis was used to account for factors that may influence patient treatment with statins. At the time of hospital admission, 815 of 2,031 symptomatic patients and 665 of 1,252 asymptomatic patients were on a statin medication. Symptomatic patients on statins had reduced in-hospital mortality and in-hospital ischemic stroke and death rates. There was no difference in in-hospital cardiac outcomes. (Adjusted odd ratios 0.25 {CI, 0.07 to 0.90}, 0.55 {CI, 0.32 to 0.95}, 0.87 {CI, 0.49 to 1.54}, respectively). Improvement in outcome of symptomatic patients was robust when tested with propensity score analysis. The association between outcomes and statin use was not seen in asymptomatic patients. Comment: The study adds to the growing impression that statins improve perioperative outcomes in patients undergoing vascular surgery. The lack of effect of statins in the asymptomatic patients undergoing carotid endarterectomy may be the result of an inability to detect the statin effect due to the low frequency of adverse events in the asymptomatic patients. Since this was not a randomized study, statins, however, may just be serving as a marker of overall better perioperative care. Results of this observational study and others like it will need to be confirmed in large multi-center randomized trials specifically addressing perioperative use of statins to improve operative outcomes.