Survival, cardiovascular morbidity, and reinterventions after elective endovascular aortic aneurysm repair in patients with and without diabetes : A nationwide propensity-adjusted analysis
(2019) In Vascular Medicine (United Kingdom) 24(6). p.539-546- 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.
(Less)
- author
- 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
- organization
- publishing date
- 2019-08-23
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- abdominal aortic aneurysm (AAA), diabetes mellitus, endovascular aneurysm repair (EVAR), mortality
- in
- Vascular Medicine (United Kingdom)
- volume
- 24
- issue
- 6
- pages
- 539 - 546
- publisher
- SAGE Publications
- external identifiers
-
- scopus:85071540402
- pmid:31441381
- 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
- 2024-08-21 08:29:57
@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}}, keywords = {{abdominal aortic aneurysm (AAA); diabetes mellitus; endovascular aneurysm repair (EVAR); mortality}}, language = {{eng}}, month = {{08}}, number = {{6}}, pages = {{539--546}}, publisher = {{SAGE Publications}}, 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}}, doi = {{10.1177/1358863X19870243}}, volume = {{24}}, year = {{2019}}, }