Diabetes mellitus as a risk factor for early outcome after carotid endarterectomy - a population-based study

Background and purpose: to determine if diabetes mellitus is a risk factor for outcome after carotid endarterectomy (CEA). Methods: the outcome and complications of all vascular procedures performed in Sweden are registered prospectively in the Swedish Vascular Registry (S wedvasc) and form the basis of tills report. During the 10-year period 1987 -96 2622 CEAs were analysed for notified complications. Results: of the 2622 CEAs, 341 (13%) were performed on diabetics and 2281 ( 87%) on non-diabetics. Patients with diabetes presented at a younger age (6 7.1 +/- 8.3 years vs, 68.2 +/- 8.3 years; p = 0.028), were more likely to h ave a history of hypertension (61.9% vs. 50%; p = 0.001) and were less ofte n smokers (34.9% vs. 43.2%; p = 0.001). Diabetics presented more often with minor stroke (41.3% vs. 30.8%; p = 0.002) and non-diabetics more often wit h amaurosis fugax (18.9% vs. 14.4%; p = 0.04). Diabetics had a higher 30-da y mortality (3.2% vs. 1.4%; p = 0.02). The 30-day neurologic and cardiac mo rbidity did not differ. The 1-year mortality was 7.9% in diabetics and 4.4% in, non-diabetics (p = 0.008). Nondiabetics operated on in 1992-96 compare d to those operated on in 1987-91 had a significantly lower combined perman ent stroke and death rate (3.7% as. 5.7%: p = 0.05), a difference nut found in diabetics (6.3% for 1987-92 and 6.8% for 1992-96; N.S.). Conclusions: diabetics had both a higher 30-day and 1-year mortality after CEA compared to non-diabetics, mainly because of cardiac complications. How ever, postoperative neurologic morbidity did not differ.