Comparison of Outcomes After Carotid Endarterectomy Between Type 2 Diabetic and Non-diabetic Patients with Significant Carotid Stenosis

Overview

Journal Cardiovasc Diabetol

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
Endocrinology

Date 2019 Mar 27

PMID 30909911

Citations 6

Authors

Min-Jae Jeong

Hyunwook Kwon

Chang Hee Jung

Sun U Kwon

Min-Ju Kim

Youngjin Han

Tae-Won Kwon

Yong-Pil Cho

Affiliations

Soon will be listed here.

Abstract

Background: We aimed to compare early and late outcomes after carotid endarterectomy (CEA) between Korean type 2 diabetic and non-diabetic patients and to investigate the impact of diabetes on the overall incidence of cardiovascular events after CEA.

Methods: We retrospectively analyzed 675 CEAs, which were performed on 613 patients with significant carotid stenosis between January 2007 and December 2014. The CEAs were divided into a type 2 diabetes mellitus (DM) group (n = 265, 39.3%) and a non-DM group (n = 410, 60.7%). The study outcomes included the incidence of major adverse events (MAEs), defined as fatal or nonfatal stroke or myocardial infarction or all-cause mortality, during the perioperative period and within 4 years after CEA.

Results: Patients in the DM and non-DM groups did not differ significantly in the incidence of MAEs or any of the individual MAE manifestations during the perioperative period. However, within 4 years after CEA, the difference in the MAE incidence was significantly greater in the DM group (P = 0.040). Analysis of the individual MAE manifestations indicated a significantly higher risk of stroke in the DM group (P = 0.006). Multivariate analysis indicated that diabetes was not associated with MAEs or individual MAE manifestations during the perioperative period, whereas within 4 years after CEA, diabetes was an independent risk factor for MAEs overall (hazard ratio [HR], 1.62; 95% confidence interval [CI] 1.06-2.48; P = 0.026) and stroke (HR, 2.55; 95% CI 1.20-5.41; P = 0.015) in particular.

Conclusions: Diabetic patients were not at greater risk of perioperative MAEs after CEA; however, the risk of late MAE occurrence was significantly greater in these patients. Within 4 years after CEA, DM was an independent risk factor for the occurrence of MAEs overall and stroke in particular.

Citing Articles

Cerebrovascular dysregulation and postoperative cognitive alterations after carotid endarterectomy.

Sandor A, Czinege Z, Szabo A, Losoncz E, Toth K, Mihaly Z Geroscience. 2024; 46(6):6301-6315.

PMID: 38877342 PMC: 11493908. DOI: 10.1007/s11357-024-01237-6.

Body Mass Index and Late Adverse Outcomes after a Carotid Endarterectomy.

Vukasinovic D, Maksimovic M, Tanaskovic S, Marinkovic J, Radak D, Maksimovic J Int J Environ Res Public Health. 2023; 20(3).

PMID: 36768056 PMC: 9916381. DOI: 10.3390/ijerph20032692.

Impact of diabetes mellitus on the frequency of post-operative complications after carotid endarterectomy.

Igrutinovic G, Nenezic D, Jakovljevic A, Elek Z, Miljkovic N, Kasalovic M Cardiovasc J Afr. 2022; 34(4):237-241.

PMID: 36374128 PMC: 10870314. DOI: 10.5830/CVJA-2022-054.

Blocking MG53 Phosphorylation Protects Diabetic Heart From Ischemic Injury.

Lv F, Wang Y, Shan D, Guo S, Chen G, Jin L Circ Res. 2022; 131(12):962-976.

PMID: 36337049 PMC: 9770150. DOI: 10.1161/CIRCRESAHA.122.321055.

Reassessing Revascularization Strategies in Coronary Artery Disease and Type 2 Diabetes Mellitus.

Liang B, He X, Gu N Front Cardiovasc Med. 2021; 8:738620.

PMID: 34746255 PMC: 8568070. DOI: 10.3389/fcvm.2021.738620.

References

Calvillo-King L, Xuan L, Zhang S, Tuhrim S, Halm E . Predicting risk of perioperative death and stroke after carotid endarterectomy in asymptomatic patients: derivation and validation of a clinical risk score. Stroke. 2010; 41(12):2786-94. PMC: 3017529. DOI: 10.1161/STROKEAHA.110.599019. View

Goodney P, Likosky D, Cronenwett J . Factors associated with stroke or death after carotid endarterectomy in Northern New England. J Vasc Surg. 2008; 48(5):1139-45. DOI: 10.1016/j.jvs.2008.05.013. View

Goodney P, Nolan B, Eldrup-Jorgensen J, Likosky D, Cronenwett J . Restenosis after carotid endarterectomy in a multicenter regional registry. J Vasc Surg. 2010; 52(4):897-904, 905.e1-2. DOI: 10.1016/j.jvs.2010.05.005. View

Welten G, Chonchol M, Hoeks S, Schouten O, Dunkelgrun M, van Gestel Y . Statin therapy is associated with improved outcomes in vascular surgery patients with renal impairment. Am Heart J. 2007; 154(5):954-61. DOI: 10.1016/j.ahj.2007.06.040. View

Rovella V, Anemona L, Cardellini M, Scimeca M, Saggini A, Santeusanio G . The role of obesity in carotid plaque instability: interaction with age, gender, and cardiovascular risk factors. Cardiovasc Diabetol. 2018; 17(1):46. PMC: 5874994. DOI: 10.1186/s12933-018-0685-0. View

Parlani G, De Rango P, Cieri E, Verzini F, Giordano G, Simonte G . Diabetes is not a predictor of outcome for carotid revascularization with stenting as it may be for carotid endarterectomy. J Vasc Surg. 2011; 55(1):79-89. DOI: 10.1016/j.jvs.2011.07.080. View

Dorigo W, Pulli R, Pratesi G, Fargion A, Marek J, Innocenti A . Early and long-term results of carotid endarterectomy in diabetic patients. J Vasc Surg. 2010; 53(1):44-52. DOI: 10.1016/j.jvs.2010.08.030. View

AbuRahma A, Stone P, Deem S, Dean L, Keiffer T, Deem E . Proposed duplex velocity criteria for carotid restenosis following carotid endarterectomy with patch closure. J Vasc Surg. 2009; 50(2):286-91, 291.e1-2. DOI: 10.1016/j.jvs.2009.01.065. View

Axelrod D, Upchurch Jr G, Demonner S, Stanley J, Khuri S, Daley J . Perioperative cardiovascular risk stratification of patients with diabetes who undergo elective major vascular surgery. J Vasc Surg. 2002; 35(5):894-901. DOI: 10.1067/mva.2002.123681. View

10.

Woodward M, Zhang X, Barzi F, Pan W, Ueshima H, Rodgers A . The effects of diabetes on the risks of major cardiovascular diseases and death in the Asia-Pacific region. Diabetes Care. 2003; 26(2):360-6. DOI: 10.2337/diacare.26.2.360. View

11.

Ricotta J, AbuRahma A, Ascher E, Eskandari M, Faries P, Lal B . Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011; 54(3):e1-31. DOI: 10.1016/j.jvs.2011.07.031. View

12.

. Risk assessment chart for death from cardiovascular disease based on a 19-year follow-up study of a Japanese representative population. Circ J. 2006; 70(10):1249-55. DOI: 10.1253/circj.70.1249. View

13.

Norgren L, Hiatt W, Dormandy J, Nehler M, Harris K, Fowkes F . Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2006; 33 Suppl 1:S1-75. DOI: 10.1016/j.ejvs.2006.09.024. View

14.

Halm E, Tuhrim S, Wang J, Rockman C, Riles T, Chassin M . Risk factors for perioperative death and stroke after carotid endarterectomy: results of the new york carotid artery surgery study. Stroke. 2008; 40(1):221-9. PMC: 2745336. DOI: 10.1161/STROKEAHA.108.524785. View

15.

Kim J, Hwang B, Choi I, Choo E, Lim S, Kim J . Impact of diabetes duration on the extent and severity of coronary atheroma burden and long-term clinical outcome in asymptomatic type 2 diabetic patients: evaluation by Coronary CT angiography. Eur Heart J Cardiovasc Imaging. 2015; 16(10):1065-73. DOI: 10.1093/ehjci/jev106. View

16.

Marrocco-Trischitta M, Melissano G, Kahlberg A, Setacci F, Abeni D, Chiesa R . Increased incidence of cerebral clamping ischemia during early contralateral carotid endarterectomy. J Vasc Surg. 2006; 43(6):1155-61. DOI: 10.1016/j.jvs.2006.02.028. View

17.

Fluri F, Hatz F, Voss B, Lyrer P, Engelter S . Restenosis after carotid endarterectomy: significance of newly acquired risk factors. Eur J Neurol. 2009; 17(3):493-8. DOI: 10.1111/j.1468-1331.2009.02858.x. View

18.

Visser L, Wallis de Vries B, Mulder D, Uyttenboogaart M, van der Veen S, Zeebregts C . The Influence of the Metabolic Syndrome on the Short- and Long-Term Outcome After Carotid Endarterectomy. Angiology. 2016; 68(4):306-314. DOI: 10.1177/0003319716664283. View

19.

Noh M, Kwon H, Jung C, Kwon S, Kim M, Lee W . Impact of diabetes duration and degree of carotid artery stenosis on major adverse cardiovascular events: a single-center, retrospective, observational cohort study. Cardiovasc Diabetol. 2017; 16(1):74. PMC: 5461631. DOI: 10.1186/s12933-017-0556-0. View

20.

Kim Y, Ahn J, Park D, Song H, Lee J, Kim W . Impact of ischemia-guided revascularization with myocardial perfusion imaging for patients with multivessel coronary disease. J Am Coll Cardiol. 2012; 60(3):181-90. DOI: 10.1016/j.jacc.2012.02.061. View