Neupane Saroj, Edla Sushruth, Maidona Eesha, Sweet Matthew C, Szpunar Susan, Davis Thomas, LaLonde Thomas A, Mehta Rajendra H, Rosman Howard S, Yamasaki Hiroshi
Division of Cardiology, St John Hospital and Medical Center, Detroit, Michigan.
School of Medicine, Wayne State University, Detroit, Michigan.
Catheter Cardiovasc Interv. 2018 Jul;92(1):117-123. doi: 10.1002/ccd.27571. Epub 2018 Mar 14.
To evaluate the association of diabetes mellitus (DM) with clinical and angiographic characteristics and outcomes of patients with popliteal and infrapopliteal peripheral arterial disease (PAD) undergoing peripheral vascular intervention (PVI).
Clinical features and outcomes in patients with DM and popliteal or infrapopliteal PAD undergoing PVI are not well described.
Using the data from the laser in popliteal and infrapopliteal stenosis study, we retrospectively examined the association of diabetes with clinical and angiographic characteristics and risk adjusted short- and intermediate term outcomes (all cause death, major adverse events (MAE) [composite of death, ipsilateral major amputation, or repeat revascularization]) in patients with popliteal and infrapopliteal PAD undergoing PVI for critical limb ischemia treated either with laser-assisted balloon angioplasty or balloon angioplasty alone.
Of 714 patients, 418 had DM (58.5%). Patients with DM were younger with higher prevalence of history of coronary artery disease, heart failure, end-stage renal disease, and prior contralateral limb amputation compared to those without DM. At 5 years, mean event free survival for all cause mortality (39.9 vs. 45.5 months; P = 0.001), MAE (29.3 vs. 36.8 months; P < 0.001), ipsilateral major amputation (55.3 vs. 57.4 months; P = 0.001), and repeat revascularization (42.0 vs. 45.8 months; P = 0.03) were significantly lower in DM patients. On multivariate analysis, DM was associated with significantly higher all cause mortality (HR = 1.83, 95% CI 1.33-2.52), MAE (HR = 1.73, 95% CI 1.35-2.23), and ipsilateral major amputation (HR = 5.52, 95% CI 1.82-16.71).
Among patients with popliteal and infrapopliteal PAD undergoing PVI, DM was associated with higher mortality, major amputations and MAE that was independent of baseline comorbidities. Our data suggested the need for future studies evaluating existing and/or novel therapies to improve the poor long-term outcomes in diabetic patients with popliteal and infrapopliteal PAD.
评估糖尿病（DM）与接受外周血管介入治疗（PVI）的腘动脉及腘以下外周动脉疾病（PAD）患者的临床和血管造影特征及预后之间的关联。
关于接受PVI的DM合并腘动脉或腘以下PAD患者的临床特征和预后描述尚不充分。
利用腘动脉和腘以下动脉狭窄激光治疗研究的数据，我们回顾性研究了糖尿病与接受PVI治疗严重肢体缺血的腘动脉及腘以下PAD患者的临床和血管造影特征以及风险调整后的短期和中期预后（全因死亡、主要不良事件（MAE）[死亡、同侧大截肢或再次血运重建的复合事件]）之间的关联，这些患者接受了激光辅助球囊血管成形术或单纯球囊血管成形术治疗。
在714例患者中，418例患有DM（58.5%）。与无DM的患者相比，DM患者更年轻，冠状动脉疾病、心力衰竭、终末期肾病和既往对侧肢体截肢史的患病率更高。在5年时，DM患者的全因死亡率无事件生存时间（39.9对45.5个月；P = 0.001）、MAE（29.3对36.8个月；P < 0.001）、同侧大截肢（55.3对57.4个月；P = 0.001）和再次血运重建（42.0对45.8个月；P = 0.03）均显著更低。多因素分析显示，DM与显著更高的全因死亡率（HR = 1.83，95%CI 1.33 - 2.52）、MAE（HR = 1.73，95%CI 1.35 - 2.23）和同侧大截肢（HR = 5.52，95%CI 1.82 - 16.71）相关。
在接受PVI的腘动脉及腘以下PAD患者中，DM与更高的死亡率、大截肢率和MAE相关，且独立于基线合并症。我们的数据表明，未来需要开展研究评估现有和/或新型疗法，以改善糖尿病合并腘动脉及腘以下PAD患者不佳的长期预后。
