Walker Karen L, Walsh Daniel B, Goodney Philip P, Connell Samantha A, Stone David H, Powell Richard J, Rzucidlo Eva M
Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
BMC Cardiovasc Disord. 2014 Dec 11;14:184. doi: 10.1186/1471-2261-14-184.
Diabetics are known to have inferior outcomes following peripheral vascular interventions. Thiazolidinediones are oral diabetic agents which improve outcomes following coronary bare metal stenting. No studies have been performed evaluating thiazolidinedione use and outcomes following lower extremity endovascular interventions. We hypothesize that diabetic patients taking thiazolidinediones at the time of primary superficial femoral artery (SFA) stenting have fewer reinterventions.
A retrospective review was performed to identify diabetic patients undergoing primary SFA stenting. The unit of analysis was the extremity. The primary outcome was freedom from target lesion revascularization stratified by thiazolidinedione use, evaluated by Kaplan Meier curves and a log rank test. A Cox proportional hazards model was constructed to determine variables associated with freedom from target lesion revascularization.
SFA stents were placed in 138 extremities in 128 diabetic patients between August 1, 2001 and July 15, 2012. Twenty-four patients were taking thiazolidinediones at the time of SFA stenting. All patients taking thiazolidinediones had TASC A or B lesions. Twenty-seven extremities in the non-thiazolidinedione group had TASC C or D lesions and were excluded to control for disease severity. Freedom from target lesion revascularization was significantly higher in diabetics taking thiazolidinediones at 2 years, 88.5% vs. 59.4%, P = 0.02, SE < 10%. Cox modeling identified a protective trend for thiazolidinedione use (thiazolidinedione use HR 0.33, 95% CI 0.09-1.13), whereas critical limb ischemia and insulin use were associated with trends for worse freedom from target lesion revascularization.
This pilot, translation study demonstrates that diabetic patients taking thiazolidinediones at the time of primary SFA stenting have decreased reintervention rates at 2 years. These results may be explained by higher adiponectin levels or other anti-inflammatory effects in patients taking thiazolidinedione. National and regional quality improvement registries should consider collecting information regarding specific diabetic regimens and use of PPAR agonists such as cilostazol and fibrates.
众所周知，糖尿病患者在接受外周血管介入治疗后预后较差。噻唑烷二酮类药物是口服降糖药，可改善冠状动脉裸金属支架置入术后的预后。尚未有研究评估噻唑烷二酮类药物在下肢血管腔内介入治疗中的应用及预后情况。我们推测，在初次股浅动脉（SFA）支架置入时服用噻唑烷二酮类药物的糖尿病患者再次干预的情况较少。
进行一项回顾性研究，以确定接受初次SFA支架置入的糖尿病患者。分析单位为肢体。主要结局是根据噻唑烷二酮类药物的使用情况分层的无靶病变血运重建，通过Kaplan-Meier曲线和对数秩检验进行评估。构建Cox比例风险模型以确定与无靶病变血运重建相关的变量。
在2001年8月1日至2012年7月15日期间，128例糖尿病患者的138个肢体置入了SFA支架。24例患者在SFA支架置入时服用噻唑烷二酮类药物。所有服用噻唑烷二酮类药物的患者均为TASC A或B级病变。非噻唑烷二酮类药物组的27个肢体为TASC C或D级病变，为控制疾病严重程度而被排除。服用噻唑烷二酮类药物的糖尿病患者在2年时无靶病变血运重建率显著更高，分别为88.5%和59.4%，P = 0.02，标准误<10%。Cox模型确定噻唑烷二酮类药物的使用有保护趋势（噻唑烷二酮类药物使用风险比0.33，95%置信区间0.09 - 1.13），而严重肢体缺血和胰岛素使用与无靶病变血运重建情况较差的趋势相关。
这项初步的转化研究表明，在初次SFA支架置入时服用噻唑烷二酮类药物的糖尿病患者在2年时再次干预率降低。这些结果可能由服用噻唑烷二酮类药物的患者中较高的脂联素水平或其他抗炎作用来解释。国家和地区质量改进登记处应考虑收集有关特定糖尿病治疗方案以及西洛他唑和贝特类等PPAR激动剂使用情况的信息。
