Periprocedural MI rates similar for carotid stenting, endarterectomy
Besides having similar MI risk factors, carotid angioplasty and stenting is associated with a comparable rate of periprocedural MI when compared with carotid endarterectomy, according to results from the journal Stroke.
The systematic review and meta-analysis involved studies published from 1980 to June 2014, along with unpublished data.
Researchers culled data on the following nine predefined risk factors: age, CAD, clinical presentation, contralateral carotid occlusion, diabetes, hypertension, peripheral artery disease, sex and type of stenosis. Included studies had available data on MI in at least one subgroup and determined absolute and relative risks along with differential effects on MI risks.
The final analysis included 52 independent studies of carotid endarterectomy (CEA; n = 62,336) and 68 of carotid angioplasty and stenting (CAS; n = 31,843).
At 30 days, the absolute risk for MI in the CEA arm was 0.87% compared with 0.7% in the CAS arm (P = .38). Among patients in the CAS group, those with symptomatic stenosis and restenosis were at increased risk for MI, whereas age, history of CAD, PAD and restenosis increased the risk for MI in the CEA group.
Furthermore, men were at a lower risk for periprocedural MI after CAS compared with women (RR = 0.6; 95% CI, 0.43-0.83); however, there were no gender discrepancies in the CEA group (RR = 1.03; 95% CI, 0.8-1.33; P for trend = .01).
The other eight risk factors were similar between groups.
“Although we found that male sex is associated with a lower risk of periprocedural MI than female sex after CAS, this should not be considered as a major criteria to select candidates for CAS, because MI is far less common than stroke, MI accounts for relatively few periprocedural deaths, and male sex is a strong risk factor for periprocedural stroke or death after CAS,” the researchers wrote. – by Brian Ellis
Disclosure: The researchers report no relevant financial disclosures.