Age and history of cardiac disease as risk factors for cardiac complications after peripheral vascular surgery in diabetic patients

Objective: To examine the relationship of age and clinical factors to posto perative cardiovascular events in a cohort of diabetic patients undergoing peripheral vascular surgery. Patients and Methods: In this cohort study, 316 diabetic patients were foll owed up prospectively after femoral-to-distal artery bypass surgery. The ma jor end points of the study were all-cause mortality and cardiac morbidity (cardiac events defined as nonfatal myocardial infarction, unstable angina, and congestive heart failure). Results: The overall postoperative cardiac event rate was 17.1% (54/316), w ith a 7.6% (24/316) rate of postoperative death or nonfatal myocardial infa rction, Older diabetic patients (greater than or equal to 65 years) had a c omplication rate of 19.9% (43/216) compared with an 11.0% (11/100) complica tion rate in younger diabetic patients (<65 years) (P=.02), Younger diabeti c patients with a clinical history of coronary artery disease had an event rate of 18.2% (39/216) compared with an event rate of 2.4% (1/42) in younge r diabetic patients without known cardiac disease (P=.02), In contrast, eve nt rates were similar (20.7% [150/208] vs 18.2% [66/108]) in older diabetic patients,vith or without prior evidence of cardiac disease. Conclusion: Advanced age and clinical evidence of coronary artery disease a re important determinants of postoperative outcome in diabetic patients und ergoing peripheral vascular surgery.