Association of Periprocedural GLP-1 Receptor Agonist Therapy With 1-Year Major Adverse Cardiovascular Events After Carotid Artery Stenting: A Propensity-Matched Analysis.

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.