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 postoperative cardiovascular events in a cohort of diabetic patients undergoing peripheral vascular surgery.


METHODS
In this cohort study, 316 diabetic patients were followed up prospectively after femoral-to-distal artery bypass surgery. The major 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), with a 7.6% (24/316) rate of postoperative death or nonfatal myocardial infarction. Older diabetic patients (> or = 65 years) had a complication rate of 19.9% (43/216) compared with an 11.0% (11/100) complication rate in younger diabetic patients (< 65 years) (P = .02). Younger diabetic 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 younger diabetic patients without known cardiac disease (P = .02). In contrast, event rates were similar (20.7% [150/208] vs 18.2% [66/108]) in older diabetic patients with or without prior evidence of cardiac disease.


CONCLUSIONS
Advanced age and clinical evidence of coronary artery disease are important determinants of postoperative outcome in diabetic patients undergoing peripheral vascular surgery.
Zarich
S W
SW
Section of Cardiology, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, Conn., USA. pszari@bpthosp.org
Pierce
E T
ET
Nesto
R W
RW
Mittleman
M A
MA
Bode
R H
RH
Kowalchuk
G
G
Cohen
M C
MC
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D015897:Comorbidity; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006331:Heart Diseases / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D012307:Risk Factors