Impact of diabetes, patient age, and gender on the 30-day incidence of stroke and death in patients undergoing carotid artery stenting with embolus protection: a post-hoc subanalysis of a prospective multicenter registry.
OBJECTIVE
To assess the impact of diabetes, patient age, and gender on major periprocedural (30-day) complications (major and minor strokes, all-cause deaths) following carotid artery stenting (CAS).


METHODS
An exploratory analysis was performed of 695 patients (516 men; mean age 69.9+/-8.4 years) enrolled consecutively between September 1999 and September 2002 in a multicenter Italian/German registry of routine CAS using cerebral protection devices. There were 535 nondiabetic patients and 160 diabetic patients in the analysis.


RESULTS
Logistic regression analysis revealed that diabetes and age, but not gender, impacted the cumulative 30-day incidence of any stroke and death (OR 2.1, 95% CI 1.0 to 4.8, p = 0.068 and OR 1.06, 95% CI 1.01 to 1.12, p = 0.031, respectively), as well as the 30-day incidence of major strokes and deaths (OR 5.9, 95% CI 1.6 to 21.8, p = 0.007 and OR 1.13, 95% CI 1.02 to 1.25, p = 0.018, respectively). According to receiver-operating characteristic analysis, age had no discriminatory power to predict complications in nondiabetic patients, but an age of 75 years was identified as the optimal cut point to predict complications in diabetic patients. Compared with nondiabetic patients, diabetics > or =75 years had a 4.3 greater risk of experiencing any stroke or death (95% CI 1.3 to 12.3, p = 0.016) and a 12.0 greater risk of a major stroke or death (95% CI 2.1 to 66.5, p = 0.005). Diabetics <75 years had no increase in risk over that of nondiabetic patients.


CONCLUSIONS
Diabetic patients > or =75 years carry a significantly increased risk for strokes or death after protected CAS. The findings should be taken into consideration when treating elderly diabetic patients.
Schlüter
Michael
M
Hamburg University Cardiovascular Center, Hamburg, Germany. schlueter@herz-hh.de
Reimers
Bernhard
B
Castriota
Fausto
F
Tübler
Thilo
T
Cernetti
Carlo
C
Cremonesi
Alberto
A
Berger
Jürgen
J
Colombo
Antonio
A
Schofer
Joachim
J
D000367:Age Factors; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000150:complications* / Q000209:etiology / Q000517:prevention & control; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D015607:Stents; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome