Dakhel Ardwan, Zarrouk Moncef, Ekelund Jan, Acosta Stefan, Nilsson Peter, Miftaraj Mervete, Eliasson Björn, Svensson Ann-Marie, Gottsäter Anders
Department of Vascular Diseases, Lund University, Skåne University Hospital, Malmö, S-205 02, Sweden.
Department of Vascular Diseases, Lund University, Skåne University Hospital, Malmö, Sweden.
Ther Adv Endocrinol Metab. 2020 Oct 19;11:2042018820960294. doi: 10.1177/2042018820960294. eCollection 2020.
Diabetes mellitus (DM) is an established risk factor for intermittent claudication (IC) and other manifestations of atherosclerotic peripheral arterial disease. Indications for surgery in infrainguinal IC are debated, and there are conflicting reports regarding its outcomes in patients with DM. Aims of this study were to compare both short- and long-term effects on total- and cardiovascular (CV) mortality, major adverse cardiovascular events (MACEs), acute myocardial infarction (AMI), stroke, and major amputation following infrainguinal endovascular surgery for IC in patients with and without DM. We also evaluated potential relationships between diabetic control and outcomes in patients with DM.
Nationwide observational cohort study of patients registered in the Swedish Vascular Registry and the Swedish National Diabetes Registry. Propensity score adjusted comparison of total and CV mortality, MACE, AMI, stroke, and major amputation after elective infrainguinal endovascular surgery for IC in 626 patients with and 1112 without DM at 30 postoperative days and after median 5.2 [interquartile range (IQR) 4.2-6.3] years of follow-up for patients with DM, and 5.4 (IQR 4.3-6.5) years for those without.
In propensity score adjusted Cox regression after 30 postoperative days, there were no differences between groups in morbidity or mortality. At last follow-up, patients with DM showed higher rates of MACE [hazard ratio (HR) 1.26, confidence interval (CI) 1.07-1.48; < 0.01], AMI (HR 1.48, CI 1.09-2.00; = 0.01), and major amputation (HR 2.31, CI 1.24-4.32; < 0.01). Among patients with DM, higher HbA1c was associated with higher total mortality during follow-up (HR 1.01, CI 1.00-1.03; = 0.045).
Patients with DM have higher rates of MACE, AMI, and major amputation in propensity score adjusted analysis during 5 years of follow-up after infrainguinal endovascular surgery for IC. Furthermore, HbA1c is associated with total mortality in patients with DM. Prevention and treatment of DM is important to improve cardiovascular and limb outcomes.
糖尿病（DM）是间歇性跛行（IC）和动脉粥样硬化性外周动脉疾病其他表现的既定危险因素。腹股沟下IC的手术指征存在争议，关于其在糖尿病患者中的治疗结果也有相互矛盾的报道。本研究的目的是比较腹股沟下IC血管腔内手术对糖尿病患者和非糖尿病患者的全因死亡率、心血管（CV）死亡率、主要不良心血管事件（MACE）、急性心肌梗死（AMI）、中风和大截肢的短期和长期影响。我们还评估了糖尿病控制与糖尿病患者预后之间的潜在关系。
对瑞典血管登记处和瑞典国家糖尿病登记处登记的患者进行全国性观察队列研究。对626例糖尿病患者和1112例非糖尿病患者进行选择性腹股沟下IC血管腔内手术后30天及糖尿病患者中位随访5.2年[四分位间距（IQR）4.2 - 6.3年]、非糖尿病患者随访5.4年（IQR 4.3 - 6.5年）后的全因死亡率、CV死亡率、MACE、AMI、中风和大截肢进行倾向评分调整比较。
术后30天倾向评分调整后的Cox回归分析显示，两组在发病率或死亡率方面无差异。在末次随访时，糖尿病患者的MACE发生率更高[风险比（HR）1.26，置信区间（CI）1.07 - 1.48；P < 0.01]、AMI发生率更高（HR 1.48，CI 1.09 - 2.00；P = 0.01）以及大截肢发生率更高（HR 2.31，CI 1.24 - 4.32；P < 0.01）。在糖尿病患者中，较高的糖化血红蛋白（HbA1c）与随访期间较高的全因死亡率相关（HR 1.01，CI 1.00 - 1.03；P = 0.045）。
在对腹股沟下IC进行血管腔内手术后5年的倾向评分调整分析中，糖尿病患者的MACE、AMI和大截肢发生率更高。此外，HbA1c与糖尿病患者的全因死亡率相关。预防和治疗糖尿病对于改善心血管和肢体预后很重要。
