J Soc Cardiovasc Angiogr Interv. 2026 Apr 24;5(6):105387. doi: 10.1016/j.jscai.2026.105387. eCollection 2026 Jun.
ABSTRACT
BACKGROUND: Major adverse cardiovascular events (MACE) following carotid artery stenting (CAS) remain clinically significant. Pharmacological strategies to reduce postprocedural cardiovascular risk beyond antiplatelet therapy and statins are limited. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) reduce MACE in patients with type 2 diabetes and established atherosclerotic cardiovascular disease; however, data evaluating GLP-1 RA therapy specifically in CAS populations are limited.
METHODS: Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of adults undergoing CAS between 2015 and 2023. Periprocedural GLP-1 RA exposure was defined as at least 1 documented prescription within ±12 months of CAS. The primary outcome was 1-year composite MACE (myocardial infarction, cerebral infarction, or all-cause mortality). Propensity score matching (1:1 nearest-neighbor) balanced 41 baseline covariates, yielding 899 matched pairs.
RESULTS: Before matching, 906 patients received periprocedural GLP-1 RA therapy and 29,476 patients had no GLP-1 RA exposure. After matching, 899 pairs (1798 patients) were analyzed. Periprocedural GLP-1 RA therapy was associated with lower 1-year composite MACE (357/899 [39.7%] vs 401/899 [44.6%]; risk ratio, 0.89; 95% CI, 0.80-0.99; P = .04), representing an absolute risk reduction of 4.9% (number needed to treat = 20). The association with composite MACE appeared largely attributable to lower observed all-cause mortality (35/899 [3.9%] vs 80/899 [8.9%]; risk ratio, 0.44; 95% CI, 0.30-0.64; P < .001), whereas myocardial infarction and cerebral infarction did not differ significantly between groups.
CONCLUSIONS: Periprocedural GLP-1 RA therapy was associated with lower 1-year MACE following CAS. These findings are hypothesis-generating and warrant prospective evaluation in carotid revascularization populations.
PMID:42516849 | PMC:PMC13404038 | DOI:10.1016/j.jscai.2026.105387