Cardiac damage after carotid intervention: a meta-analysis after a decade of randomized trials

This study synthesizes evidence from randomized controlled trials of the past decade regarding the relative safety of carotid endarterectomy (CEA) versus carotid angioplasty and stenting (CAS) as concerns postoperative cardiac damage. We searched Medline, Embase, and Cochrane Central through November 2013 to December 2013. We determined trial eligibility and extracted descriptive, methodological, and outcome data related to cardiac damage after open or endovascular treatment. Cardiac damage was defined as evidence of symptomatic or asymptomatic myocardial ischemia/infarction. Nine trials (5,959 patients) were eligible for enrollment in this review. CAS was associated with a decreased risk for cardiac damage in all trials (pooled RR = 0.37; 95 % CI = 0.22-0.61, I (2) = 11 %, P = 0.0001), and specifically in the latest two randomized trials that show fewer methodological flaws (RR = 0.39; 95 % CI = 0.23-0.69, P = 0.03). CAS was associated with 11.5 fewer cardiac events (from 14.7 fewer to 6.3 fewer) compared to CEA. Compared to open surgery, CAS is associated with significantly decreased risk for symptomatic and asymptomatic cardiac damage postoperatively. Therefore, a standardized troponin measurement after CEA should be further evaluated in future studies.