1234. Systematic review and meta-analysis of perioperative and long-term outcomes in patients receiving statin therapy before carotid endarterectomy

Authors: Natasha Ironside, MbChB; Daniel Brenner, BA; Eric Heyer, MD; Ching-Jen Chen, MD; Trae Robison, BA; Brandon Christophe, BA; Edward Connolly, Jr., MD (Rockville, MD)

Introduction: Carotid endarterectomy (CEA) is associated with perioperative stroke and mortality in a minority of cases. This systematic review and meta-analysis sought to investigate the effect of pre-operative statins on perioperative outcomes in patients undergoing CEA for internal carotid artery (ICA) stenosis. Methods: A systematic review of PubMed, Medline and the Cochrane Database of Systematic Reviews was performed. Included studies reported perioperative stroke and/or survival outcomes following CEA for ICA stenosis and compared patients who were and were not taking pre-operative statins. Relevant data were extracted and pooled using meta-analysis. Results: Seven studies met the inclusion criteria, comprising 21,387 patients. 68.9% (14,976) were administered statins and 31.1% (6,657) were statin-free. Pre-operative statin use was higher in patients with a history of cardiac disease (12.2% vs. 23.6% in the statin-free group), diabetes (31.6% vs. 25.1% in the statin-free group) and hypertension (83.5% vs. 72.2% in the statin-free group), while a greater proportion of statin-free patients had symptomatic disease (44.9% vs. 55.5% in the statin-free group). Statins were associated with reduced perioperative stroke in all patients (OR 0.57; 95% C.I. 0.34 – 0.95; p = 0.03) and in symptomatic patients (OR 0.57; 95% C.I. 0.35 – 0.93; p = 0.03). A trend towards lower perioperative mortality (OR 0.54; 95% C.I. 0.29, 1.03; p = 0.06) and significantly improved overall survival was observed in the statin group (HR 0.69; 95% C.I. 0.59 – 0.81; p<0.001) at a mean follow-up of 62 months (range: 27–76 months). Conclusion: Administration of statins before CEA is associated with lower rates of perioperative stroke and improved overall survival. Compliance with optimal medical treatment associated with the use of pre-operative statins may limit the clinical significance of these findings. Future investigation to characterize the potential benefit of statin therapy in patients undergoing CEA for ICA stenosis, is warranted.