Abstract 10902: Prognostic Value of HbA1C Among Patients with Diabetes Undergoing Infrapopliteal Percutaneous Interventions
Background: Diabetes mellitus (DM) is a significant risk factor for restenosis after endovascular intervention, but the contribution of glycemic control to infra-popliteal artery restenosis is unknown.
Methods: All endovascular infra-popliteal interventions among patients with DM from 2006-2010 were reviewed. Pre-procedure HbA1C was used to group patients into high (> 7.0) and low (≤ 7.0) HbA1c groups. The primary endpoint was restenosis at six months. The secondary end point was major adverse cardiovascular events (MACE) over two-year follow-up, which included death, myocardial infarction, stroke, or major amputation.
Results: 113 infra-popliteal lesions in 61 patients with DM were treated with percutaneous intervention during the study period. Thirty patients had HbA1c levels ≤7.0 (mean HbA1C 6.3 ± 0.6%) and 31 had HbA1c levels >7.0 (mean HbA1C 9.6 ± 2.0%, p< 0.001). Baseline demographic and lesion characteristics were similar between groups (Table). At six months, primary patency as determined by duplex ultrasound or need for target lesion revascularization was 82% for patients with HbA1C ≤ 7.0, compared to 50% for patients with HbA1C > 7.0 (HR 2.8 for restenosis for HbA1C > 7.0, p = 0.03). Two-year MACE was also significantly higher among patients with HbA1C >7.0 (HR 4.5, p = 0.05). Increased MACE was largely attributable to higher rates of major amputation at two years: 24% in the high HbA1C group and 7% in the low HbA1C group (p=0.05).
Conclusions: An HbA1c level >7.0 at the time of infra-popliteal endovascular intervention is associated with increased rates of restenosis and subsequent MACE, including major amputation.
- © 2012 by American Heart Association, Inc.