Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis
Abstract. Background:. There is still uncertainty regarding whether diabetes mellitus (DM) can adversely affect patients undergoing carotid endarterectomy (CEA) for carotid stenosis. The aim of the study was to assess the adverse impact of DM on patients with carotid stenosis treated by CEA. Meth...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-06-01
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| Series: | Chinese Medical Journal |
| Online Access: | http://journals.lww.com/10.1097/CM9.0000000000002730 |
| _version_ | 1827913145108135936 |
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| author | Fengshi Li Rui Zhang Xiao Di Shuai Niu Zhihua Rong Changwei Liu Leng Ni Xiangxiang Pan Peifang Wei |
| author_facet | Fengshi Li Rui Zhang Xiao Di Shuai Niu Zhihua Rong Changwei Liu Leng Ni Xiangxiang Pan Peifang Wei |
| author_sort | Fengshi Li |
| collection | DOAJ |
| description | Abstract.
Background:. There is still uncertainty regarding whether diabetes mellitus (DM) can adversely affect patients undergoing carotid endarterectomy (CEA) for carotid stenosis. The aim of the study was to assess the adverse impact of DM on patients with carotid stenosis treated by CEA.
Methods:. Eligible studies published between 1 January 2000 and 30 March 2023 were selected from the PubMed, EMBASE, Web of Science, CENTRAL, and ClinicalTrials databases. The short-term and long-term outcomes of major adverse events (MAEs), death, stroke, the composite outcomes of death/stroke, and myocardial infarction (MI) were collected to calculate the pooled effect sizes (ESs), 95% confidence intervals (CIs), and prevalence of adverse outcomes. Subgroup analysis by asymptomatic/symptomatic carotid stenosis and insulin/noninsulin-dependent DM was performed.
Results:. A total of 19 studies (n = 122,003) were included. Regarding the short-term outcomes, DM was associated with increased risks of MAEs (ES = 1.52, 95% CI: [1.15–2.01], prevalence = 5.1%), death/stroke (ES = 1.61, 95% CI: [1.13–2.28], prevalence = 2.3%), stroke (ES = 1.55, 95% CI: [1.16–1.55], prevalence = 3.5%), death (ES = 1.70, 95% CI: [1.25–2.31], prevalence =1.2%), and MI (ES = 1.52, 95% CI: [1.15–2.01], prevalence = 1.4%). DM was associated with increased risks of long-term MAEs (ES = 1.24, 95% CI: [1.04–1.49], prevalence = 12.2%). In the subgroup analysis, DM was associated with an increased risk of short-term MAEs, death/stroke, stroke, and MI in asymptomatic patients undergoing CEA and with only short-term MAEs in the symptomatic patients. Both insulin- and noninsulin-dependent DM patients had an increased risk of short-term and long-term MAEs, and insulin-dependent DM was also associated with the short-term risk of death/stroke, death, and MI.
Conclusions:. In patients with carotid stenosis treated by CEA, DM is associated with short-term and long-term MAEs. DM may have a greater impact on adverse outcomes in asymptomatic patients after CEA. Insulin-dependent DM may have a more significant impact on post-CEA adverse outcomes than noninsulin-dependent DM. Whether DM management could reduce the risk of adverse outcomes after CEA requires further investigation. |
| first_indexed | 2024-03-13T02:26:09Z |
| format | Article |
| id | doaj.art-8c22ec19863f4f42a1144b8cbfaacab2 |
| institution | Directory Open Access Journal |
| issn | 0366-6999 2542-5641 |
| language | English |
| last_indexed | 2024-03-13T02:26:09Z |
| publishDate | 2023-06-01 |
| publisher | Wolters Kluwer |
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| series | Chinese Medical Journal |
| spelling | doaj.art-8c22ec19863f4f42a1144b8cbfaacab22023-06-30T01:54:37ZengWolters KluwerChinese Medical Journal0366-69992542-56412023-06-01136121401140910.1097/CM9.0000000000002730202306200-00003Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysisFengshi Li0Rui Zhang1Xiao Di2Shuai Niu3Zhihua Rong4Changwei Liu5Leng Ni6Xiangxiang PanPeifang Wei1Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China2Department of Breast Oncoplastic Surgery, Hunan Cancer Hospital & The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410031, China.1Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China1Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China1Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China1Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China1Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, ChinaAbstract. Background:. There is still uncertainty regarding whether diabetes mellitus (DM) can adversely affect patients undergoing carotid endarterectomy (CEA) for carotid stenosis. The aim of the study was to assess the adverse impact of DM on patients with carotid stenosis treated by CEA. Methods:. Eligible studies published between 1 January 2000 and 30 March 2023 were selected from the PubMed, EMBASE, Web of Science, CENTRAL, and ClinicalTrials databases. The short-term and long-term outcomes of major adverse events (MAEs), death, stroke, the composite outcomes of death/stroke, and myocardial infarction (MI) were collected to calculate the pooled effect sizes (ESs), 95% confidence intervals (CIs), and prevalence of adverse outcomes. Subgroup analysis by asymptomatic/symptomatic carotid stenosis and insulin/noninsulin-dependent DM was performed. Results:. A total of 19 studies (n = 122,003) were included. Regarding the short-term outcomes, DM was associated with increased risks of MAEs (ES = 1.52, 95% CI: [1.15–2.01], prevalence = 5.1%), death/stroke (ES = 1.61, 95% CI: [1.13–2.28], prevalence = 2.3%), stroke (ES = 1.55, 95% CI: [1.16–1.55], prevalence = 3.5%), death (ES = 1.70, 95% CI: [1.25–2.31], prevalence =1.2%), and MI (ES = 1.52, 95% CI: [1.15–2.01], prevalence = 1.4%). DM was associated with increased risks of long-term MAEs (ES = 1.24, 95% CI: [1.04–1.49], prevalence = 12.2%). In the subgroup analysis, DM was associated with an increased risk of short-term MAEs, death/stroke, stroke, and MI in asymptomatic patients undergoing CEA and with only short-term MAEs in the symptomatic patients. Both insulin- and noninsulin-dependent DM patients had an increased risk of short-term and long-term MAEs, and insulin-dependent DM was also associated with the short-term risk of death/stroke, death, and MI. Conclusions:. In patients with carotid stenosis treated by CEA, DM is associated with short-term and long-term MAEs. DM may have a greater impact on adverse outcomes in asymptomatic patients after CEA. Insulin-dependent DM may have a more significant impact on post-CEA adverse outcomes than noninsulin-dependent DM. Whether DM management could reduce the risk of adverse outcomes after CEA requires further investigation.http://journals.lww.com/10.1097/CM9.0000000000002730 |
| spellingShingle | Fengshi Li Rui Zhang Xiao Di Shuai Niu Zhihua Rong Changwei Liu Leng Ni Xiangxiang Pan Peifang Wei Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis Chinese Medical Journal |
| title | Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis |
| title_full | Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis |
| title_fullStr | Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis |
| title_full_unstemmed | Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis |
| title_short | Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis |
| title_sort | diabetes mellitus and adverse outcomes after carotid endarterectomy a systematic review and meta analysis |
| url | http://journals.lww.com/10.1097/CM9.0000000000002730 |
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