Myocardial Infarction After Carotid Endarterectomy and Stenting

Study Questions:

What is the absolute risk of periprocedural myocardial infarction (MI) and the absolute risk of periprocedural death after carotid angioplasty and stenting (CAS) and carotid endarterectomy (CEA)?

Methods:

The investigators performed a systematic review and a meta-analysis of studies published from January 1980 to June 2014, and collected unpublished data. They extracted data on nine predefined risk factors (age, contralateral carotid occlusion, coronary artery disease, diabetes mellitus, sex, hypertension, peripheral artery disease, type stenosis, and clinical presentation). The authors selected studies with data available on MI in at least one subgroup, calculated absolute and relative risks, and identified differential effects on risks of MI.

Results:

The 30-day absolute risk of MI was 0.87% (95% confidence interval, 0.69–1.07) after CEA and 0.70% (95% confidence interval, 0.54–0.88) after CAS (Pint = 0.38). After CAS, patients with symptomatic stenosis and restenosis were at higher risk of MI, whereas men were at lower risk. After CEA, age, history of coronary artery disease, peripheral artery disease, and restenosis increased the risk of MI. Only the effect of sex differed between CAS and CEA with men being at lower risk of MI than women after CAS, whereas there was no difference between after CEA (Pint = 0.01).

Conclusions:

The authors concluded that risk of MI after CEA and CAS did not significantly differ.

Perspective:

This systemic review reports that the 30-day absolute risk of MI was not significantly higher after CEA than after CAS, and that there were no major risk factors that could help to identify patients with a differential risk of MI after CEA versus CAS. Stroke is the main cause of periprocedural death after carotid revascularization and risk factors for periprocedural stroke, and death should continue to be used in selecting the most appropriate intervention for individual patients.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Vascular Medicine

Keywords: Angioplasty, Atherosclerosis, Carotid Stenosis, Constriction, Pathologic, Coronary Artery Disease, Endarterectomy, Carotid, Myocardial Infarction, Peripheral Arterial Disease, Risk Factors, Stents, Stroke


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