Statins Influence Long Term Restenosis and Cardiovascular Events Following Carotid Endarterectomy

Efthymios   D.   Avgerinos; John   D.   Kakisis; Konstantinos   G.   Moulakakis; Triantafillos   G.   Giannakopoulos; George      Sfyroeras; Constantinos   N.   Antonopoulos; Nikolaos   P.   Kadoglou; Christos   D.   Liapi

Abstract

Objective: To evaluate the impact of statins on carotid restenosis (CR) >50% and future cardiovascular events (CVE), in patients undergoing carotid endarterectomy (CEA).

Methods: 570 consecutive patients (656 CEAs) operated between 1990 and 2009, were included in this retrospective study. The study cohort was followed for an average of 82 months (median 80, range 12- 180 months). Endpoints were the development of CR >50%, the occurrence of CVE (myocardial infarction, stroke) and overall mortality. Kaplan-Meier curves and Cox regression models were used to assess outcomes.

Results: 92 restenosis events were recorded. Freedom from restenosis >50% at 5, 10 and 15 years of follow-up was 92, 82 and 69%, respectively. Compared with statin-receivers, statin-free patients had a significantly higher 15-year restenosis rate (41 vs 10%; P = .001), a significantly higher CVE rate (49 vs 14%; P = .001) and a significantly higher mortality rate (24 vs 18%; P = .034). Adjusting for other covariates statins were independently associated with lower restenosis rate (hazard ratio [HR], 0.52; 95% CI, 0.31-0.88; P= .016), cardiovascular events (HR, 0.40; 95% CI, 0.26-0.61; P < 0.001) and long-term mortality (HR, 0.56; 95% CI, 0.33-0.95; P = .032).

Conclusion: Statins not only reduce cardiovascular events and mortality but may also have an important effect on the anatomic durability of CEA. These data support the use of statins in patients with carotid stenosis undergoing CEA.

Keywords: Carotid endarterectomy, restenosis, mortality, echolucent plaque, statins.

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