Comparative Effectiveness of Carotid Endarterectomy versus Carotid Stenting in Type 2 Diabetic Patients with Symptomatic or Asymptomatic Carotid Stenosis: A Real-World Data Analysis
Author(s)
Yuqing Fan, MSc1, Nan Peng, Ph.D.2, Linfeng Jiang, MSc1, Dongning Yao, Ph.D.1, Dr. Shitong Xie, PhD3.
1Nanjing Medical University, Nanjing, China, 2China Pharmaceutical University, Nanjing, China, 3Tianjin University, Tianjin, China.
1Nanjing Medical University, Nanjing, China, 2China Pharmaceutical University, Nanjing, China, 3Tianjin University, Tianjin, China.
OBJECTIVES: Type 2 diabetes is associated with higher perioperative risks during carotid revascularization procedures. However, the comparative effectiveness of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in this patient population remains unclear. This study aims to compare the incidence of adverse events during hospitalization in type 2 diabetes patients undergoing CEA or CAS.
METHODS: A retrospective analysis was conducted using 2016-2021 U.S. National Inpatient Sample data. This study included patients with type 2 diabetes and symptomatic or asymptomatic carotid stenosis who underwent CEA or CAS. A doubly robust estimation method was employed to evaluate the incidence of adverse events, including all-cause mortality, stroke, and myocardial infarction. This approach involved an inverse probability weighting (IPW) model, followed by logistic regression to adjust for residual confounding variables and estimate the association between interventions and outcomes.
RESULTS: A total of 31,363 asymptomatic patients (CAS, n = 6,338; CEA, n = 25,025) and 3,710 symptomatic patients (CAS, n = 1,271; CEA, n = 2,439) with carotid stenosis were evaluated. Among asymptomatic patients, the CEA group demonstrated lower rates of mortality (OR: 0.997, 95% CI: 0.995-0.999, p = 0.011) and stroke (OR: 0.959, 95% CI: 0.952-0.966, p < 0.001) compared to the CAS group. However, a higher incidence of myocardial infarction was observed in the CEA group (OR: 1.005, 95% CI: 1.001-1.008, p = 0.007). Similarly, among symptomatic patients, the CEA group had lower mortality (OR: 0.973, 95% CI: 0.961-0.985, p < 0.001) and stroke (OR: 0.973, 95% CI: 0.952-0.994, p = 0.014) rates compared to the CAS group. No statistically significant difference in myocardial infarction incidence was found between the two groups.
CONCLUSIONS: The study found a modest benefit of CEA over CAS in type 2 diabetics. Further research is warranted to establish causality and explore long-term outcomes.
METHODS: A retrospective analysis was conducted using 2016-2021 U.S. National Inpatient Sample data. This study included patients with type 2 diabetes and symptomatic or asymptomatic carotid stenosis who underwent CEA or CAS. A doubly robust estimation method was employed to evaluate the incidence of adverse events, including all-cause mortality, stroke, and myocardial infarction. This approach involved an inverse probability weighting (IPW) model, followed by logistic regression to adjust for residual confounding variables and estimate the association between interventions and outcomes.
RESULTS: A total of 31,363 asymptomatic patients (CAS, n = 6,338; CEA, n = 25,025) and 3,710 symptomatic patients (CAS, n = 1,271; CEA, n = 2,439) with carotid stenosis were evaluated. Among asymptomatic patients, the CEA group demonstrated lower rates of mortality (OR: 0.997, 95% CI: 0.995-0.999, p = 0.011) and stroke (OR: 0.959, 95% CI: 0.952-0.966, p < 0.001) compared to the CAS group. However, a higher incidence of myocardial infarction was observed in the CEA group (OR: 1.005, 95% CI: 1.001-1.008, p = 0.007). Similarly, among symptomatic patients, the CEA group had lower mortality (OR: 0.973, 95% CI: 0.961-0.985, p < 0.001) and stroke (OR: 0.973, 95% CI: 0.952-0.994, p = 0.014) rates compared to the CAS group. No statistically significant difference in myocardial infarction incidence was found between the two groups.
CONCLUSIONS: The study found a modest benefit of CEA over CAS in type 2 diabetics. Further research is warranted to establish causality and explore long-term outcomes.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO97
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)