Association of obesity and diabetes mellitus with early and late outcomes after carotid endarterectomy

[D. Vukašinović]

118, [16] str.

Medicina - Ekološki i nutritivni faktori i zdravlje / Medicine - Environmental and nutritional factors and health

Uvod: Podaci o povezanosti dijabetesa melitusa (DM) i gojaznosti sa ishodima karotidne endarterektomije (KEA) nisu konzistentni, a uticaj njihovog istovremenog prisustva na rezultate KEA je nedovoljno ispitan. Cilj: Ispitivanje pojedinačnog i zajedničkog uticaja DM i gojaznosti, kao i drugih potencijalnih faktora rizika, na pojavu ranih i kasnih nepovoljnih ishoda KEA. Metod: Kohortnom studijom je obuhvaćeno 1597 KEA urađenih kod 1533 pacijenta Klinike za vaskularnu hirurgiju Instituta za kardiovaskularne bolesti „Dedinje“ u Beogradu, u periodu 2012-2017. Pacijenti su praćeni 4 godine od operacije. Rezultati: Tip 1 DM (T1DM) nije bio povezan sa ranim nepovoljnim ishodima KEA. Od kasnih nepovoljnih ishoda, pacijenti sa T1DM su češće imali infarkt miokarda, smrtni ishod i restenozu. Pacijenti sa tipom 2 DM (T2DM) su češće imali TIA/moždani udar, smrtni ishod, respiratorne komplikacije i reoperacije od ranih nepovoljnih ishoda, kao i sve kasne nepovoljne ishode izuzev infarkta miokarda. Predgojaznost i gojaznost nisu bili povezani sa ranim i kasnim nepovoljnim ishodima KEA. Jedini izuzetak su bila perioperativna krvarenja koja su bila ređa kod predgojaznih. Gojazni pacijenti sa DM su, u odnosu na pacijente bez DM, češće imali TIA/moždani udar, smrtni ishod i respiratorne komplikacije od ranih nepovoljnih ishoda, kao i moždani udar i restenozu od kasnih. Između gojaznih i negojaznih pacijenata sa DM nije bilo razlike u učestalosti ni ranih ni kasnih komplikacija posle KEA. Prediktori glavnih ranih nepovoljnih ishoda KEA bili su prethodna perkutana koronarna intervencija i povišeni trigliceridi, dok su aspirin i ACEI u terapiji na otpustu bili protektivni. Prediktori glavnih kasnih nepovoljnih ishoda KEA bili su T1DM, uzrast, periferna arterijska bolest, kontralateralna karotidna stenoza i OAK u terapiji na otpustu. Rekreativna fizička aktivnost pre operacije identifikovana je kao protektivni faktor za pojavu kasnog infarkta miokarda/moždanog udara. Zaključak: Identifikovani prediktori nepovoljnih ishoda KEA ukazuju na potrebu korekcije životnih navika i precizniji odabir medikamentne terapije.

Introduction: Data on the association of diabetes mellitus (DM) and obesity with carotid endarterectomy (CEA) outcomes are inconsistent, and the effect of their simultaneous presence on the results of CEA is insufficiently investigated. Aim: To investigate the individual and simultaneous effect of DM and obesity, as well as the effect of other potential risk factors on the occurrence of early and late adverse outcomes of CEA. Method: The cohort study included 1597 CEA performed in 1533 patients at the Clinic for Vascular Surgery, Institute for Cardiovascular Diseases "Dedinje" in Belgrade, from 2012-2017. Patients were followed for 4 years after surgery. Results: Type 1 DM (T1DM) was not associated with early adverse outcomes of CEA. Regarding the late adverse outcomes, patients with T1DM had myocardial infarction, death and restenosis more frequently. Patients with type 2 DM (T2DM) had more freaquently TIA/stroke, death, respiratory complications and reoperations as early adverse outcomes, as well as all late adverse outcomes except myocardial infarction. Overweight and obesity were not associated with early and late adverse outcomes of CEA. The only exception was perioperative bleeding, which was less frequent in overweight patients. Obese patients with DM, compared to patients without DM, had more freaquently TIA/stroke, death and respiratory complications as early adverse outcomes, as well as stroke and restenosis as late adverse outcomes. Between obese and non-obese patients with DM there were no differences in the frequency of neither early nor late complications after CEA. Predictors of the early major adverse outcomes of CEA were previous percutaneous coronary intervention and higher triglyceride levels, while aspirin and ACEI in discharge therapy were protective. Predictors of the late major adverse outcomes of CEA were T1DM, age, peripheral arterial disease, contralateral carotid stenosis and OAK in discharge therapy. Preoperative recreational physical activity has been identified as a protective factor for the occurrence of late myocardial infarction/stroke. Conclusion: Identified predictors of adverse CEA outcomes indicate the need for correction of lifestyle habits and more precise selection of medical therapy.

karotidna endarterektomija, rani nepovoljni ishodi, kasni nepovoljni ishodi, dijabetes melitus, gojaznost, prediktori

carotid endarterectomy, early adverse outcomes, late adverse outcomes, diabtes mellitus, obesity, predictors

613.2:616.13-089.85(043.3)

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