Survival Benefit of Optimal Glycemic Control in Diabetic Patients Undergoing Endovascular Therapy for Femoropopliteal Disease

초록

Background The influence of optimal glycemic control in diabetic patients on macrovascular complications is unclear. This study investigated the impact of optimal glycemic control on the clinical outcomes after endovascular therapy (EVT) for femoropopliteal artery (FPA) disease in diabetic patients. Methods Diabetic patients who underwent EVT for FPA lesions were enrolled from a Korean multicenter EVT registry and were divided according to the preprocedural hemoglobin A1c level during index admission into the optimal (<7.0%) or suboptimal (≥7.0%) glycemic control groups. The primary endpoints were all-cause mortality and major adverse limb events at 2 years. Propensity score matching was used to reduce biases. Results Of the 1,066 patients enrolled (849 men, mean age = 69.4 years), 444 (41.7%) were in the optimal glycemic control group and 622 (58.3%) in the suboptimal group. After propensity score matching, 244 patients were allocated to each group. Although no significant differences were found between the 2 groups regarding major adverse limb events, all-cause mortality was higher in the suboptimal group (log-rank P = 0.016) during the 2-year follow-up (Figure). In the multivariate Cox regression model, suboptimal glycemic control was 1 of the independent predictors for all-cause mortality (HR: 2.62; 95% CI: 1.40-4.93; P = 0.003). Conclusion In diabetics undergoing EVT for FPA disease, suboptimal preprocedural hemoglobin A1c is associated with higher all-cause mortality.