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Survival, cardiovascular morbidity, and reinterventions after elective endovascular aortic aneurysm repair in patients with and without diabetes : A nationwide propensity-adjusted analysis

Taimour, Soumia LU ; Avdic, Tarik; Franzén, Stefan; Zarrouk, Moncef LU ; Acosta, Stefan LU ; Nilsson, Peter LU ; Miftaraj, Mervete; Eliasson, Björn; Svensson, Ann Marie and Gottsäter, Anders LU (2019) In Vascular Medicine (United Kingdom)
Abstract

Epidemiological data indicate decreased risk for development and growth of abdominal aortic aneurysm (AAA) among patients with diabetes mellitus (DM). On the other hand, DM adds to increased cardiovascular (CV) morbidity and mortality. In a nationwide observational cohort study of patients registered in the Swedish Vascular Register and the Swedish National Diabetes Register, we evaluated potential effects of DM on total mortality, CV morbidity, and the need for reintervention after elective endovascular aneurysm repair (EVAR) for AAA. We compared 748 patients with and 2630 without DM with propensity score-adjusted analysis, during a median 4.22 years of follow-up for patients with DM, and 4.05 years for those without. In adjusted... (More)

Epidemiological data indicate decreased risk for development and growth of abdominal aortic aneurysm (AAA) among patients with diabetes mellitus (DM). On the other hand, DM adds to increased cardiovascular (CV) morbidity and mortality. In a nationwide observational cohort study of patients registered in the Swedish Vascular Register and the Swedish National Diabetes Register, we evaluated potential effects of DM on total mortality, CV morbidity, and the need for reintervention after elective endovascular aneurysm repair (EVAR) for AAA. We compared 748 patients with and 2630 without DM with propensity score-adjusted analysis, during a median 4.22 years of follow-up for patients with DM, and 4.05 years for those without. In adjusted analysis, diabetic patients showed higher rates of acute myocardial infarction (AMI) during follow-up (relative risk (RR) 1.44, 95% CI 1.06–1.95; p = 0.02), but lower need for reintervention (RR 0.12, CI 0.02–0.91; p = 0.04). There were no differences in total (RR 0.88, CI 0.74–1.05; p = 0.15) or CV (RR 1.58, CI 0.87–2.86; p = 0.13) mortality, or stroke (RR 0.95, CI 0.68–1.32; p = 0.75) during follow-up. In conclusion, patients with DM had higher rates of AMI and lower need for reintervention after elective EVAR than those without DM, whereas neither total nor CV mortality differed between groups. The putative protective effects of DM towards further AAA enlargement and late sac rupture may help explain the lower need for reintervention and absence of excess mortality.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
abdominal aortic aneurysm (AAA), diabetes mellitus, endovascular aneurysm repair (EVAR), mortality
in
Vascular Medicine (United Kingdom)
publisher
SAGE Publications Inc.
external identifiers
  • scopus:85071540402
ISSN
1358-863X
DOI
10.1177/1358863X19870243
language
English
LU publication?
yes
id
5554e28a-1ee5-4039-ac42-5d1c2bd30c76
date added to LUP
2019-09-23 13:17:36
date last changed
2019-10-08 03:59:02
@article{5554e28a-1ee5-4039-ac42-5d1c2bd30c76,
  abstract     = {<p>Epidemiological data indicate decreased risk for development and growth of abdominal aortic aneurysm (AAA) among patients with diabetes mellitus (DM). On the other hand, DM adds to increased cardiovascular (CV) morbidity and mortality. In a nationwide observational cohort study of patients registered in the Swedish Vascular Register and the Swedish National Diabetes Register, we evaluated potential effects of DM on total mortality, CV morbidity, and the need for reintervention after elective endovascular aneurysm repair (EVAR) for AAA. We compared 748 patients with and 2630 without DM with propensity score-adjusted analysis, during a median 4.22 years of follow-up for patients with DM, and 4.05 years for those without. In adjusted analysis, diabetic patients showed higher rates of acute myocardial infarction (AMI) during follow-up (relative risk (RR) 1.44, 95% CI 1.06–1.95; p = 0.02), but lower need for reintervention (RR 0.12, CI 0.02–0.91; p = 0.04). There were no differences in total (RR 0.88, CI 0.74–1.05; p = 0.15) or CV (RR 1.58, CI 0.87–2.86; p = 0.13) mortality, or stroke (RR 0.95, CI 0.68–1.32; p = 0.75) during follow-up. In conclusion, patients with DM had higher rates of AMI and lower need for reintervention after elective EVAR than those without DM, whereas neither total nor CV mortality differed between groups. The putative protective effects of DM towards further AAA enlargement and late sac rupture may help explain the lower need for reintervention and absence of excess mortality.</p>},
  author       = {Taimour, Soumia and Avdic, Tarik and Franzén, Stefan and Zarrouk, Moncef and Acosta, Stefan and Nilsson, Peter and Miftaraj, Mervete and Eliasson, Björn and Svensson, Ann Marie and Gottsäter, Anders},
  issn         = {1358-863X},
  keyword      = {abdominal aortic aneurysm (AAA),diabetes mellitus,endovascular aneurysm repair (EVAR),mortality},
  language     = {eng},
  month        = {08},
  publisher    = {SAGE Publications Inc.},
  series       = {Vascular Medicine (United Kingdom)},
  title        = {Survival, cardiovascular morbidity, and reinterventions after elective endovascular aortic aneurysm repair in patients with and without diabetes : A nationwide propensity-adjusted analysis},
  url          = {http://dx.doi.org/10.1177/1358863X19870243},
  year         = {2019},
}