Effect of Triple Antiplatelet Therapy on Diabetic Patients Who Underwent Endovascular Treatment for Peripheral Artery Disease

초록

Background No large-scale study has compared the clinical impact of triple (TAPT) and dual (DAPT) antiplatelet therapy on adverse limb events in diabetic patients after endovascular therapy for peripheral artery disease. In this study, we investigated the effect of cilostazol as TAPT on clinical outcomes of endovascular therapy in diabetic patients using a nationwide, multicenter, real-world registry. Methods A total of 990 diabetic patients who underwent endovascular therapy were enrolled from the retrospective cohorts of a Korean multicenter endovascular therapy registry and were divided according to the antiplatelet regimen (TAPT vs DAPT). The primary end points were major adverse limb events (MALE: a composite of major amputation, minor amputation, and reintervention). Results Of the 990 patients enrolled (762 men, overall mean age 68.7 ± 8.7 years), 350 (35.4%) were classified into the TAPT group and 640 (64.6%) into the DAPT group. Technical success rate, in-hospital events, and immediate procedural complications were not different between the 2 groups. The TAPT group had lower incidences of MALE and minor amputation than the DAPT group. No significant differences were found between the 2 groups regarding overall survival, major amputation, reintervention, and major bleeding. In the multivariate Cox regression model, TAPT was one of the independent predictors for minor amputation. The same results were found after propensity score matching. When the data were analyzed according to the initial presentation, the incidence of minor amputation was significantly decreased in the TAPT group compared with the DAPT group only in patients with critical limb ischemia. Conclusion In diabetic patients undergoing endovascular therapy for peripheral artery disease, TAPT is associated with a decreased risk of adverse limb events, especially in patients with critical limb ischemia. Categories ENDOVASCULAR: Peripheral Vascular Disease and Intervention