A prospective study of 289 diabetic patients with lower extremity arteriosclerosis obliterans (LEASO) undergoing endovascular revascularization demonstrates that preprocedural HbA1c ≥7.0% increases 1-year major adverse cardiovascular event (MACE) risk by 2.1-fold and major adverse limb event (MALE) risk substantially, establishing preprocedural glycemic optimization as a clinically actionable strategy before peripheral artery disease revascularization.
The association between preprocedural glycemia and major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs) after endovascular revascularization in diabetic patients with lower extremity arteriosclerosis obliterans (LEASO) has been unclear. The current prospective study addresses this clinically important question directly.
Diabetes mellitus is a major risk factor for peripheral artery disease and for adverse outcomes following PAD revascularization. The bidirectional relationship, diabetes drives PAD development, and PAD outcomes are worse in diabetic patients, has implications for procedural planning and perioperative care.
The prospective study enrolled 289 diabetic LEASO patients undergoing endovascular revascularization. Using multivariate Cox regression models, the analysis assessed hazard ratios between baseline glycemia (HbA1c and fasting plasma glucose) and 1-year MACEs/ MALEs. Optimal glycemic thresholds for outcome prediction were determined.
In 289 patients, 344 target vessels were successfully opened. Over a mean 1.3-year follow-up, 55 patients had MACEs and 68 patients had MALEs. The substantial event rates support meaningful statistical assessment of glycemicoutcome relationships.
Preprocedural HbA1c ≥7.0% increased MACEs risk by 2.1-fold (HR 3.112, 95% CI 1.291-7.502; p=0.011). The clinically relevant HbA1c threshold of 7%, the conventional glycemic target for most diabetic patients, emerges as the inflection point for substantially elevated post-revascularization MACEs risk.
MALEs risk was similarly elevated by elevated preprocedural HbA1c, with amputation events particularly concerning given their devastating clinical impact. The 1-year outcome framework captures the clinically meaningful intermediateterm risk window for PAD revascularization outcomes.
Implications for clinical practice include consideration of preprocedural glycemic optimization before elective PAD revascularization in diabetic patients. While urgent revascularization for limb threats cannot wait for glycemic optimization, elective cases may benefit from preprocedural HbA1c improvement targeted toward <7.0%.
Take-home: preprocedural HbA1c ≥7.0% increases 1-year MACEs and MALEs after PAD endovascular revascularization in diabetic patients, supporting preprocedural glycemic optimization as a strategy to improve revascularization outcomes. The findings inform PAD treatment planning and perioperative glycemic management in this clinically important patient population.
“Preprocedural HbA1c ≥7.0% triples post-PADrevascularization MACE risk in diabetics, glycemic optimization before elective revascularization gains direct evidence.”