Mortality, Cardiovascular and Limb Events in Patients With Symptomatic Lower Extremity Artery Disease and Diabetes

François-Xavier Lapébie (1, 2) , Vanina Bongard (3, 4, 2) , Philippe Lacroix (5, 6) , Victor Aboyans (7, 6) , Joël Constans (8, 9) , Carine Boulon (9) , Emmanuel Messas (10, 11) , Florence Thomas-Delecourt (12) , David Rosenbaum (12) , Jean Ferrières (3, 2, 4) , Alessandra Bura-Rivière (13, 1)

1 Service de Médecine Vasculaire [CHU Toulouse]
2 Equipe Vieillissement (CERPOP)
3 Service Epidémiologie clinique et santé publique [CHU Toulouse]
4 Fédération de Cardiologie [CHU Toulouse]
5 Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges]
6 EpiMaCT - Epidémiologie des Maladies Chroniques en zone tropicale
7 Service de cardiologie [CHU Limoges]
8 UB - Université de Bordeaux
9 CHU Bordeaux
10 Service de médecine vasculaire et hypertension artérielle [CHU HEGP]
11 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
12 AstraZeneca
13 STROMALab

The aim of this study was to compare the prognosis of patients according to diabetes status, during a 1-year follow-up after hospital admission for lower extremity artery disease, in the prospective COPART (COhorte de Patients ARTériopathes) registry. Inclusion criteria were intermittent claudication, ischemic rest pain, tissue loss, or acute limb ischemia, with radiological and hemodynamic confirmation. Among 2494 patients, 1235 (49.5%) had diabetes. Incidence rates for major adverse cardiovascular events (MACE) were 18.0/100 person-years (95% confidence interval [CI], 15.4–21.0) for the diabetes group and 11.1/100 person-years (95% CI, 9.2–13.4) for the non-diabetes group. Incidence rates of all-cause mortality were 29.8/100 person-years (95% CI, 26.5–33.4) for the diabetes group and 19.7/100 person-years (95% CI, 17.2–22.7) for the non-diabetes group. Incidence rates of major limb amputation were 24.2/100 person-years (95% CI, 21.1–27.8) for the diabetes group and 11.6/100 person-years (95% CI, 9.6–14.0) for the non-diabetes group. Diabetes was associated with MACE, adjusted hazard ratio 1.60 (95% CI, 1.16–2.22), and all-cause mortality, unadjusted HR 1.49 (95% CI, 1.24–1.78). In the multivariate analysis, diabetes was no longer associated with major amputation, adjusted HR 1.15 (95% CI, .87–1.51). Patients hospitalized for LEAD with diabetes had a higher risk of MACE than those without diabetes.

Mots clés: amputation; cohort studies; diabetes mellitus; major adverse cardiovascular events; mortality

Domaines: Santé publique et épidémiologie

François-Xavier Lapébie, Vanina Bongard, Philippe Lacroix, Victor Aboyans, Joël Constans, et al.. Mortality, Cardiovascular and Limb Events in Patients With Symptomatic Lower Extremity Artery Disease and Diabetes. Angiology, 2022, 73 (6), pp.528-538. ⟨10.1177/00033197211050144⟩. ⟨hal-03707349⟩