Statins reduce mortality and failure to rescue after carotid artery stenting

Objective: The benefit of statins has been well established in reducing morbidities and mortality after carotid endarterectomy. However, the potential advantage of statin use in patients undergoing carotid artery stenting (CAS) remains largely unknown. The purpose of this study was to evaluate the effect of statins on postoperative outcomes after CAS. Methods: The Premier Healthcare Database was retrospectively analyzed to identify all patients who underwent CAS from 2009 to 2015. Univariate (χ² test, t-test) and multivariate models (logistic regression) were used to evaluate the effect of statins on postoperative outcomes. Results: A total of 17,800 patients underwent CAS during the study period; 12,416 (70%) patients were taking statins. The statin group had more symptomatic patients (41% vs 31%; P < .001) and had significantly higher comorbidities including hypertension, diabetes, coronary artery disease, dyslipidemia, history of congestive heart failure, history of stroke, history of myocardial infarction (MI), and peripheral artery disease (all P < .05). Postoperative mortality was 1.0% vs 1.8% in the statin and nonstatin groups, respectively (P < .001). Statin use had no effect on odds of postoperative stroke (odds ratio [OR], 1.09; 95% confidence interval [CI], 0.88-1.34; P = .44) and higher odds of MI (OR, 2.08; 95% CI, 1.26-3.45; P = .004). After adjustment for potential confounders, statins were associated with 64% reduction in the odds of death (OR, 0.36; 95% CI, 0.27-0.47; P < .001) and 18% reduction in stroke/death (OR, 0.82; 95% CI, 0.68-0.99; P = .03). In patients who had a stroke or MI, statin users had significantly lower failure to rescue (lower mortality) compared with nonstatin users (11.4% vs 30.8%; P < .001). Conclusions: 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.