Department of Vascular Diseases, Lund University, Skåne University Hospital, Malmö, Sweden.
Swedish National Diabetes Register, Gothenburg, Sweden.
Vasa. 2021 Apr;50(3):224-230. doi: 10.1024/0301-1526/a000929. Epub 2020 Dec 18.
Diabetes mellitus (DM) is a risk factor for peripheral arterial disease (PAD). Indications for open surgery in infrainguinal intermittent claudication (IC) are limited, and reports are lacking regarding outcomes in DM patients. Study aims were to compare short and long-term effects on major adverse cardiovascular events (MACE), acute myocardial infarction (AMI), stroke, major amputation, and mortality after infrainguinal open surgery for IC in patients with and without DM, and to evaluate relationships between glycaemic control and outcomes. Nationwide observational cohort study of all patients registered in the Swedish Vascular Registry after planned infrainguinal open surgery for IC from January 1 2010 to December 31 2014. Patients registered in the National Diabetes Registry were compared with patients without diabetes by propensity score adjusted comparison of MACE, AMI, stroke, major amputation, and mortality. After 30 days, there were no differences in MACE, AMI, stroke, major amputation, or mortality between patients with (n = 323, mean age 70.5 [SD 7.4] years, 92 [28.5%] females) and without (n = 679, mean age 69.7 years [SD 11.2], 234 [34.5%] females) DM. At last follow-up after median 5.2 years, patients with DM showed higher rates of MACE (Hazard ratio [HR] 1.33, confidence interval [CI] 1.08-1.62; p < 0.01), and AMI (HR 2.21, CI 1.46-3.35; p < 0.01) than patients without diabetes. Among DM patients, higher glycated haemoglobin (HbA1c) was associated with higher rates of MACE (HR 1.02, CI 1.00-1.03; p = 0.02), stroke (HR 1.05, CI 1.00-1.11; p = 0.04), and total mortality (HR 1.03, CI 1.01-1.06; p < 0.01), during follow-up, whereas duration of diabetes was associated with higher rate of major amputation (HR 1.08, CI 1.02-1.15; p < 0.01). DM patients showed higher rates of MACE and AMI in propensity score adjusted analysis five years after planned infrainguinal open surgery for IC. Higher HbA1c was associated with MACE, stroke, and total mortality in patients with DM, whereas longer duration of DM was associated with major amputation.
糖尿病（DM）是外周动脉疾病（PAD）的一个危险因素。在股浅间歇跛行（IC）中，开放手术的适应证有限，并且缺乏关于 DM 患者结局的报告。研究目的是比较 DM 患者和非 DM 患者接受股浅动脉开放手术后主要不良心血管事件（MACE）、急性心肌梗死（AMI）、中风、大截肢和死亡率的短期和长期影响，并评估血糖控制与结局之间的关系。这是一项对 2010 年 1 月 1 日至 2014 年 12 月 31 日计划行股浅动脉开放手术治疗 IC 的所有患者在瑞典血管登记处注册的患者进行的全国性观察性队列研究。将登记在国家糖尿病登记处的患者与无糖尿病的患者进行比较，通过 MACE、AMI、中风、大截肢和死亡率的倾向性评分调整比较。在 30 天后，DM 患者（n=323，平均年龄 70.5[SD 7.4]岁，92[28.5%]名女性）与非 DM 患者（n=679，平均年龄 69.7 岁[SD 11.2]，234[34.5%]名女性）之间在 MACE、AMI、中风、大截肢或死亡率方面无差异。在中位随访 5.2 年后的最后一次随访中，DM 患者的 MACE（风险比 [HR] 1.33，置信区间 [CI] 1.08-1.62；p<0.01）和 AMI（HR 2.21，CI 1.46-3.35；p<0.01）发生率高于非糖尿病患者。在 DM 患者中，较高的糖化血红蛋白（HbA1c）与较高的 MACE（HR 1.02，CI 1.00-1.03；p=0.02）、中风（HR 1.05，CI 1.00-1.11；p=0.04）和总死亡率（HR 1.03，CI 1.01-1.06；p<0.01）发生率相关，而糖尿病病程与大截肢（HR 1.08，CI 1.02-1.15；p<0.01）发生率相关。DM 患者在计划行股浅动脉开放手术后 5 年的倾向性评分调整分析中显示出更高的 MACE 和 AMI 发生率。较高的 HbA1c 与 DM 患者的 MACE、中风和总死亡率相关，而较长的糖尿病病程与大截肢相关。
