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Influence of preprocedural glycemic control on clinical outcomes of endovascular therapy in diabetic patients with lower extremity artery disease: an analysis from a Korean multicenter retrospective registry cohort

 Jung-Joon Cha  ;  Hyoeun Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Jae-Hwan Lee  ;  Chang-Hwan Yoon  ;  In-Ho Chae  ;  Cheol Woong Yu  ;  Seung Whan Lee  ;  Sang-Rok Lee  ;  Seung Hyuk Choi  ;  Yoon Seok Koh  ;  Pil-Ki Min  ;  K-VIS (Korean Vascular Intervention Society) investigators 
 CARDIOVASCULAR DIABETOLOGY, Vol.19(1) : 97, 2020-06 
Journal Title
Issue Date
Clinical outcomes ; Diabetes mellitus ; Endovascular treatment ; Glucose control ; Glycated hemoglobin A ; Peripheral artery disease
Background: The influence of intensive glucose control in diabetic patients on the macrovascular outcomes is controversial. Thus, this study aimed to elucidate the effect of preprocedural hemoglobin A1c (HbA1c) on clinical outcomes after endovascular therapy for lower extremity artery disease (LEAD) in diabetic patients.

Methods: Diabetic patients were enrolled from the retrospective cohorts of a Korean multicenter endovascular therapy registry and were divided according to the HbA1c level during index admission into the optimal (< 7.0%) or suboptimal (≥ 7.0%) glycemic control groups. The primary endpoints were major adverse limb events (MALE, a composite of major amputation, minor amputation, and reintervention).

Results: Of the 1103 patients enrolled (897 men, mean age 68.2 ± 8.9 years), 432 (39.2%) were classified into the optimal glycemic control group and 671 (60.8%) into the suboptimal glycemic control group. In-hospital events and immediate procedural complications were not different between the two groups. The suboptimal group showed a trend towards a higher incidence of MALE than the optimal group (log-rank p = 0.072). Although no significant differences were found between the two groups in terms of overall survival or amputation, the risk of reintervention was significantly higher in the suboptimal group (log-rank p = 0.048). In the multivariate Cox regression model, suboptimal glycemic control was one of the independent predictors for reintervention. When our data were analyzed according to the initial presentation, suboptimal preprocedural HbA1c significantly increased the incidence of MALE compared with optimal preprocedural HbA1c only in patients with intermittent claudication.

Conclusion: In diabetic patients undergoing endovascular therapy for LEAD, suboptimal preprocedural HbA1c is associated with an increased risk of adverse limb events, especially in patients with intermittent claudication. Further prospective research will be required to validate the role of more intensive glycemic control on the reduction of adverse limb events in diabetic patients undergoing endovascular therapy for LEAD.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Min, Pil Ki(민필기) ORCID logo https://orcid.org/0000-0001-7033-7651
Cha, Jung-Joon(차정준) ORCID logo https://orcid.org/0000-0002-8299-1877
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
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