Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy.
Acta Diabetol. 2022 Oct;59(10):1331-1338. doi: 10.1007/s00592-022-01932-w. Epub 2022 Jul 21.
The aim of the current study is to evaluate the association between below-the-ankle (BTA) arterial disease and coronary artery disease (CAD) in patients with diabetic foot ulcers (DFUs).
The study group was composed of patients with an active neuro-ischaemic DFUs managed in a tertiary care diabetic foot clinic. All patients received a pre-set limb salvage protocol including lower limb revascularization. By a retrospective analysis of individual angiograms, patients were divided in two groups: below-the-ankle (BTA) and above-the-ankle (ATA) arterial disease groups. The rate of CAD at baseline assessment and the new events of acute myocardial ischaemia (AMI) during 1-year of follow-up were evaluated and compared between the two groups.
Two hundreds seventy-two (272) patients were included, 120 (44.1%) showed BTA arterial disease while 152 (55.9%) ATA arterial disease. The mean age was 68.9 ± 9.6 years, 198 (72.8%) were male, 246 (90.4%) had type 2 diabetes, the mean diabetes duration was 20.7 ± 11.6 years, the mean HbA1c was 7.8 ± 4.2% (62 ± 22 mmmol/mol). The whole population reported CAD in 172 cases (63.4%), and the rate in the BTA group was significantly higher than in ATA group, respectively, 90 (75.4%) vs 82 (54.1%), p < 0.0001. During the follow-up, BTA group had 5% of new cases of AMI in comparison to 1.3% in ATA group (p < 0.001). At the multivariate analysis BTA resulted an independent marker of CAD [OR 1.9 CI 9 5% (1.3-4.5) p = 0.0001].
The current study shows a significant association between BTA arterial disease and CAD. A close cardiovascular screen should be required in patients with DFUs.
本研究旨在评估糖尿病足溃疡（DFU）患者踝下动脉（BTA）疾病与冠状动脉疾病（CAD）之间的关联。
研究组由在三级保健糖尿病足诊所接受治疗的活动神经缺血性 DFU 患者组成。所有患者均接受下肢血运重建的预设肢体挽救方案。通过对个体血管造影的回顾性分析，将患者分为踝下（BTA）和踝上（ATA）动脉疾病两组。评估并比较两组患者在基线评估时 CAD 的发生率和 1 年随访期间新发急性心肌缺血（AMI）事件的发生率。
共纳入 272 例患者，120 例（44.1%）存在 BTA 动脉疾病，152 例（55.9%）存在 ATA 动脉疾病。平均年龄为 68.9±9.6 岁，198 例（72.8%）为男性，246 例（90.4%）为 2 型糖尿病患者，糖尿病病程平均为 20.7±11.6 年，平均 HbA1c 为 7.8±4.2%（62±22 mmmol/mol）。所有患者中共有 172 例（63.4%）报告存在 CAD，BTA 组的发生率明显高于 ATA 组，分别为 90 例（75.4%）和 82 例（54.1%），p<0.0001。在随访期间，BTA 组新发 AMI 病例占 5%，而 ATA 组占 1.3%（p<0.001）。多变量分析显示，BTA 是 CAD 的独立标志物[比值比 1.9，95%可信区间（1.3-4.5），p=0.0001]。
本研究表明，BTA 动脉疾病与 CAD 之间存在显著关联。DFU 患者应进行密切的心血管筛查。
