Impact of critical limb ischemia on long-term cardiac mortality in diabetic patients undergoing percutaneous coronary

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Francesco Liistro1, Paolo Angioli, Simone Grotti

  • 1Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy. francescoliistro@hotmail.com

Diabetes Care
|January 24, 2013
PubMed

Insights

Promptly treated critical limb ischemia (CLI) in diabetic patients with coronary artery disease (CAD) did not increase long-term cardiac mortality. Early endovascular intervention for CLI in this population showed no significant association with cardiac death risk.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diabetology

Background:

  • Critical limb ischemia (CLI) is a known predictor of cardiac mortality in diabetic patients.
  • Diabetic patients with symptomatic coronary artery disease (CAD) are at high risk for cardiovascular events.

Purpose of the Study:

  • To investigate the impact of CLI, managed with early endovascular intervention, on long-term cardiac mortality in diabetic patients with CAD.
  • To assess if structured CLI management affects cardiac outcomes in this high-risk group.

Main Methods:

  • Prospective observational study of 764 diabetic patients undergoing percutaneous coronary intervention (PCI).
  • CLI development was monitored by a dedicated diabetic foot clinic.
  • Cardiac mortality was assessed at 4-year follow-up.

Main Results:

  • 111 patients (14%) developed CLI and underwent revascularization with 96% procedural success.
  • CLI patients had poorer baseline characteristics, including lower ejection fraction and higher dialysis rates.
  • At 4-year follow-up, cardiac mortality was not significantly different between CLI and non-CLI groups (9% vs. 6%, P=0.2).
  • CLI was not associated with increased cardiac mortality risk (HR 1.08, P=0.1).

Conclusions:

  • Promptly assessed and aggressively treated CLI in diabetic patients with CAD is not significantly associated with increased long-term cardiac mortality.
  • Early endovascular intervention for CLI may mitigate cardiac risks in diabetic patients with concomitant CAD.
Abstract

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