Statins reduce mortality and failure to rescue after carotid artery stenting

Rizwan, Muhammad; Faateh, Muhammad; Dakour-Aridi, Hanaa; Nejim, Besma; Alshwaily, Widian

doi:10.1016/j.jvs.2018.03.424

Cited by 21 publications

(16 citation statements)

References 39 publications

(48 reference statements)

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“…We insure that all our patients are on statin and aspirin as well as β-blockers and for CAS dual antiplatelet agents is mandatory. 15,16 Statins have been shown to be protective for mortality following CEA and CAS in previous studies; similarly in this study, statins have shown 71% reduction in mortality. 16,17 We patch all our CEA under EEG and evoked potential monitoring with selective shunting.…”

Section: Discussionsupporting

confidence: 80%

Long-Term Outcomes of Carotid Endarterectomy and Carotid Artery Stenting When Performed by a Single Vascular Surgeon

Rizwan

Aridi

Dang

et al. 2019

Vasc Endovascular Surg

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Objectives: Carotid artery endarterectomy (CEA) and carotid artery stenting (CAS) are 2 effective treatment options for carotid revascularization and stroke prevention. The long-term outcomes of Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) reported similar stroke and death rate between the 2 procedures. This study presents the short-and longterm outcomes of CEA and CAS of all risk patients performed by a single vascular surgeon in a real-world setting. Methods: We retrospectively reviewed all patients who underwent CEA and CAS from September 2005 to June 2017 at our institute. Student t test, w 2 , and Fisher exact tests were used to compare patient's characteristics. Multivariate logistic, cox regression models and survival analysis were used to compare postoperative and long-term outcomes between the 2 groups. Results: Over 2000 patients were evaluated for carotid artery stenosis during the study period, and 313 revascularization procedures were performed (CEA: 47%, CAS: 53%). Patients' age (Mean [95% confidence interval, CI] 68.8 [67.2-70.4] vs 69.7 [68.2-71.3], P ¼ .40) was similar between CEA and CAS. Patients who underwent CAS had significantly higher comorbidities (chronic obstructive pulmonary disease [COPD], chronic heart failure [CHF], hyperlipidemia, and prior ipsilateral intervention, all P < .05). No difference was found in 30-day complications after CEA versus CAS including stroke (2.0% vs 1.2%), myocardial infarction (MI; 0.7% vs 1.2%), death (0% vs 1.2%) as well as combined major adverse events (stroke/death/MI; 2.7% vs 3.0%; all P > .05). Overall 7-year survival, stroke-free survival and restenosis-free survival were similar between the 2 groups (P > .5). Significant predictors of mortality were diabetes (hazard ratio, HR [95% CI]: 2.41 [1.15-5.08]), chronic kidney disease (HR [95% CI]: 4.89 [1.97-12.13]), and COPD (HR [95% CI]: 3.31 [1.43-7.71]; all P values <.05). Statin use was protective with 71% reduction in risk of mortality (HR [95% CI]: 0.29 [0.12-0.67], P ¼ .004). Conclusion: Our experience showed comparable short-and long-term outcomes of CAS and CEA performed for carotid artery stenosis by vascular surgeon. There was no difference between single institutional long-term outcomes and CREST outcomes following CEA and CAS.

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Section: Discussionsupporting

confidence: 80%

Long-Term Outcomes of Carotid Endarterectomy and Carotid Artery Stenting When Performed by a Single Vascular Surgeon

Rizwan

Aridi

Dang

et al. 2019

Vasc Endovascular Surg

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“…However, this latter evidence was only borderline significant, and the study did not consider time-dependent events that could have influenced mortality, thus misestimating the potential beneficial effect of statins on different outcomes. Similar results on post-operative mortality were shown in the recent large retrospective analysis of Rizwan et al on data of the Premier Healthcare Database, a large American database that includes data of more than 700 U.S. hospitals [ 6 ].…”

Section: Introductionsupporting

confidence: 77%

“…The protective effect of statins on the onset of peri-procedural complications and long-term cardiovascular events and mortality after angioplasty and stenting has been demonstrated in coronary and other arterial sites [ 4 , 20 ], as well as in carotid surgical endarterectomy [ 21 ]. Previous studies have extended this evidence also in carotid artery stenosis regarding peri-procedural complications [ 6 , 11 , 13 ] and 5-years mortality [ 5 ]. Our study confirms previous observations showing a beneficial effect of statins on survival rate and extends this observation over 8 years after CAS procedure also providing additional evidence of beneficial effect of these drugs on new MACE occurrence and, particularly, on the new onset of fatal and non-fatal stroke.…”

Section: Discussionmentioning

confidence: 83%

Pre-Procedural Statin Use Is Associated with Improved Long-Term Survival and Reduced Major Cardiovascular Events in Patients Undergoing Carotid Artery Stenting: A Retrospective Study

Colussi

Zuttion

Bais

et al. 2018

JCM

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Carotid artery stenting (CAS) is a minimal invasive procedure used to resolve carotid occlusion that can be affected by peri-procedural complications. Statin use before CAS has shown to reduce peri-procedural risk and improve survival, though time-dependent cofactors that influence mortality has not been considered. The aim of this study was to evaluate long-term survival of patients who undergo CAS considering new occurred major adverse cardiovascular event (MACE) as time-dependent cofactor. In this study, 171 high cardiovascular risk patients (age 72 ± 8 years, 125 males) were enrolled after CAS procedure and were followed for a median of 8.4 years. Death occurred in 44% of patients with a mean time to death of 69 ± 39 months and MACE in 34% with a mean time of 35 ± 42 months. In patients who used or not statins at baseline, death occurred in 33% and 65%, respectively (p < 0.001). Survival analysis showed that statin use reduced risk of death (hazard ratio HR 0.36, 95% confidence interval CI 0.23–0.58, p < 0.0001). Including MACE as time-dependent variable did not change beneficial effects of statins. Additionally, statin use was associated with a protective effect on MACE (HR 0.48, 95% CI 0.27–0.85, p = 0.012); particularly, the prevalence of stroke was reduced by 59% (p = 0.018). In multivariate analysis, effects of statins were independent of demographic and anthropometric variables, prevalence of cardiovascular risk factors, renal function, antiplatelet use, and MACE occurrence. In conclusion, use of statins before CAS procedure is associated with increased long-term survival and reduced MACE occurrence. This evidence supports the hypothesis that statin use before CAS might be beneficial in high risk patients.

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“…Studies of statin use in CEA or carotid artery stent (CAS) surgery show apparent reductions in major adverse cardiac and cerebrovascular events (MACE), including a nearly fourfold reduction in stroke and seven-fold reduction in mortality. 33,34 In a recent large study of CAS, 35 a subgroup analysis showed greatest benefit from statins in patients with no history of coronary artery or cerebrovascular disease, with 67% and 40% reduction in mortality and stroke, respectively, suggesting that statins may be more effective if intervention is undertaken earlier to prevent development of large unstable plaques.…”

Section: Perioperative Statins For Major Surgerymentioning

confidence: 99%

The case for statin use to reduce perioperative adverse cardiovascular and cerebrovascular events

Ratcliffe

Rothwell

2020

British Journal of Anaesthesia

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Ischaemic heart disease and stroke are the leading causes of death worldwide at 119 per 100,000 and 85 per 100,000 population. For the USA, heart disease is leading cause of death at 165 per 100,000 population. In developed countries, strokes and acute myocardial infarction in the general population have fallen from smoking reduction, lifestyle modifications and therapeutic interventions including statins. In a population-based stroke study in the UK involving primary care practices, of in-hospital strokes 90% were ischaemic, and 37% occurred within 1 week of an operation. Approximately 50% of the patients were not on a statin. In the UK, there is a national screening initiative for the prevention of atherosclerotic cardiovascular disease (ASCVD) offered to people aged 40-74 yr old. The QRISK3 tool calculates the risk of developing heart disease or stroke over 10 yr, from which recommendations are made on interventions for the prevention of ASCVD up to age 84 yr, with similar screening and assessment tools in Europe and the US. If the QRISK3 score tool for calculating cardiovascular risk is considered sufficiently robust for population screening in primary care, should anaesthetists not use the same screening for secondary care? We present a case for statin use over the perioperative period, to reduce early vascular adverse events based on statins' early pleiotropic actions, using the primary care QRISK tool for screening of ASCVD risk.

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Statins reduce mortality and failure to rescue after carotid artery stenting

Abstract: Statin use is associated with significant reduction in mortality and failure to rescue in patients who develop major complications (stroke/MI) after CAS. Therefore, statin use should be strongly encouraged in all patients undergoing CAS.

Cited by 21 publications

References 39 publications

Long-Term Outcomes of Carotid Endarterectomy and Carotid Artery Stenting When Performed by a Single Vascular Surgeon

Long-Term Outcomes of Carotid Endarterectomy and Carotid Artery Stenting When Performed by a Single Vascular Surgeon

Pre-Procedural Statin Use Is Associated with Improved Long-Term Survival and Reduced Major Cardiovascular Events in Patients Undergoing Carotid Artery Stenting: A Retrospective Study

The case for statin use to reduce perioperative adverse cardiovascular and cerebrovascular events

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