Diabetes Mellitus with Chronic Complications in Relation to Carotid Endarterectomy and Carotid Artery Stenting Outcomes

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• 作者：Oluwole Adegbala ; MPH^* ; ^&dagger ; ; Kimberly D. Martin ; PhD^&dagger ; ; David Otuada ; PhD^&Dagger ; ; Tomi Akinyemiju ; PhD^&dagger ; ; ^{tomiakin@uab.edu}
• 关键词：Diabetes mellitus ; carotid endarterectomy ; carotid artery ; stenting ; mortality ; hospitalization outcomes
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：26
• 期：1
• 页码：217-224
• 全文大小：137 K
• 卷排序：26

文摘

Carotid endarterectomy and carotid artery stenting are effective treatment procedures for carotid artery stenosis. Although diabetes mellitus is highly prevalent among patients undergoing these revascularization procedures, few studies have examined their impact on periprocedural outcomes.ObjectivesThe study aimed to determine whether perioperative outcomes among patients undergoing carotid artery stenting and carotid endarterectomy varied depending on the presence of diabetes with or without chronic complications.MethodsWe examined adults aged 45 and above hospitalized between 2007 and 2011 in U.S. hospitals who underwent carotid artery revascularization procedures. We used data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample and evaluated the influence of diabetes with or without chronic complications on outcomes.ResultsAmong patients receiving carotid artery stenting, diabetic patients with chronic complications had significantly increased odds of acute kidney injury (odds ratio [OR]: 3.17, 95% confidence interval [CI]: 2.31-4.35) and longer hospital stay (β: 1.98, 95% CI: 1.58-2.38) compared with nondiabetic patients. Diabetic patients with chronic complications receiving carotid endarterectomy experienced increased odds of myocardial infarction (OR: 1.12, 95% CI: .90-1.40), stroke (OR: 1.29, 95% CI: .97-1.72), perioperative infection (OR: 2.45, 95% CI: 1.29-4.65), mortality (OR: 1.48, 95% CI: 1.01-2.16), and longer hospital stay (β (days): 2.05, 95% CI: 1.90-2.20) compared with nondiabetic patients. No significant increased odds of perioperative outcomes were observed among diabetic patients without chronic complications.ConclusionsUncomplicated diabetes did not appear to convey a higher odds of perioperative outcomes among patients undergoing revascularization. However, the presence of diabetes with chronic complications is an important risk factor in the carotid endarterectomy category.