Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 5;8(3):298-306.
doi: 10.1093/ehjqcco/qcaa095.

Diabetes mellitus and outcomes of lower extremity revascularization for peripheral artery disease

Nipun Bhandari  1 , Jonathan D Newman  1 , Jeffrey S Berger  1   2 , Nathaniel R Smilowitz  1   3
Affiliations

Diabetes mellitus and outcomes of lower extremity revascularization for peripheral artery disease

Nipun Bhandari et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Aims: The impact of diabetes mellitus (DM) on outcomes of lower extremity revascularization (LER) for peripheral artery disease (PAD) is uncertain. We characterized associations between DM and post-procedural outcomes in PAD patients undergoing LER.

Methods and results: Adults undergoing surgical or endovascular LER were identified from the 2014 Nationwide Readmissions Database. DM was defined by ICD-9 diagnosis codes and sub-classified based on the presence or absence of complications (poor glycaemic control or end-organ damage). Major adverse cardiovascular and limb events (MACLEs) were defined as the composite of death, myocardial infarction, ischaemic stroke, or major limb amputation during the index hospitalization for LER. For survivors, all-cause 6-month hospital readmission was determined. Among 39 441 patients with PAD hospitalized for LER, 50.8% had DM. The composite of MACLE after LER was not different in patients with and without DM after covariate adjustment, but patients with DM were more likely to require major limb amputation [5.5% vs. 3.2%, P < 0.001; adjusted odds ratio (aOR) 1.22, 95% confidence interval (CI) 1.03-1.44] and hospital readmission (59.2% vs. 41.3%, P < 0.001; aOR 1.44, 95% CI 1.34-1.55). Of 20 039 patients with DM hospitalized for LER, 55.7% had DM with complications. These patients were more likely to have MACLE after LER (11.1% vs. 5.2%, P < 0.001; aOR 1.56 95% CI 1.28-1.89) and require hospital readmission (61.1% vs. 47.2%, P < 0.001; aOR 1.41 95% CI 1.27-1.57) than patients with uncomplicated DM.

Conclusions: DM is present in ≈50% of patients undergoing LER for PAD and is an independent risk factor for major limb amputation and 6-month hospital readmission.

Keywords: Cardiovascular outcomes; Diabetes mellitus; Hospital readmissions; Lower extremity revascularization; Peripheral artery disease.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Characteristics of the index hospitalization by diabetes mellitus status including indication for revascularization (A) and endovascular vs. surgical approach to revascularization (B).
Figure 2
Figure 2
Cumulative incidence of hospital readmission within 6 months following in-hospital surgical or endovascular lower extremity revascularization by diabetes mellitus status including diabetes mellitus vs. no diabetes mellitus (A) and diabetes mellitus with complications vs. diabetes mellitus without complications (B).
See this image and copyright information in PMC

References

    1. Song P, Rudan D, Zhu Y, Fowkes FJI, Rahimi K, Fowkes FGR et al. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. Lancet Glob Health 2019;7:e1020–e1030. - PubMed
    1. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation 2017;135:e726–e779. - PMC - PubMed
    1. Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: epidemiology, mechanisms, and outcomes. World J Diabetes 2015;6:961–969. - PMC - PubMed
    1. Vrsalovic M, Vucur K, Vrsalovic Presecki A, Fabijanic D, Milosevic M. Impact of diabetes on mortality in peripheral artery disease: a meta-analysis. Clin Cardiol 2017;40:287–291. - PMC - PubMed
    1. Newman JD, Wilcox T, Smilowitz NR, Berger JS. Influence of diabetes on trends in perioperative cardiovascular events. Diabetes Care 2018;41:1268–1274. - PMC - PubMed

Publication types

MeSH terms