Long-term Survival and Cardiovascular Morbidity after Elective Open Aortic Aneurysm Repair in Patients with and without Type 2 Diabetes: A Nationwide Propensity-Adjusted Analysis

Abstract

Epidemiological data indicate decreased risk for development and growth of abdominal aortic aneurysm (AAA) among patients with diabetes mellitus (DM), but DM also goes with increased cardiovascular (CV) morbidity and mortality. We evaluated the effects of DM on mortality and CV morbidity after elective open AAA repair. This is a nationwide observational cohort study of patients registered in the Swedish Vascular Registry and the Swedish National Diabetes Register. Comparison of mortality and CV morbidity after elective open AAA repair in 397 patients with and 1709 without DM with propensity score-adjusted analysis, during median 4.51years of follow-up for patients with DM and 4.59years for those without. In adjusted analysis, diabetic patients showed higher rates of acute myocardial infarction (AMI) (relative risk [RR] 1.57, 95% confidence interval [CI] 1.04-2.36; P=0.03) and major adverse cardiovascular events (MACEs, RR 1.28, CI 1.04-1.58; P=0.02) during follow-up, whereas there were no differences in total (RR 0.98, CI 0.75-1.29; P=0.91) or CV (RR 0.30, CI 0.07-1.26; P=0.10) mortality or stroke (RR 1.06, CI 0.67-1.67; P=0.80). Among diabetic patients, higher HbA1c was related to a higher risk for AMI during follow-up (RR 1.04, CI 1.01-1.08; P=0.02). Patients with DM had higher rates of AMI and MACE after elective open AAA repair than those without DM, whereas neither total nor CV mortality differed between groups. Putative beneficial effects of DM on the aortic wall might not be relevant after open surgery including thrombus removal and aneurysmorrhaphy.