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February 12, 2020

Study Reports Impact of Diabetes on 5-Year Outcomes After Endovascular Therapy for PAD

February 12, 2020—Findings from a study evaluating the long-term impact of diabetes mellitus in patients with peripheral artery disease (PAD) who underwent endovascular therapy were published by Michael S. Lee, MD, et al in Vascular Medicine (2020;25:33–40).

As summarized in Vascular Medicine, the prospective registry was composed of 765 patients who underwent endovascular therapy for symptomatic PAD, with 560 patients who had diabetes and 205 who did not. Propensity score matching (PSM) analysis was performed to adjust for any potential confounders. The primary endpoints were 5-year major adverse cardiac and cerebrovascular events (MACE) and major adverse limb events (MALE).

The investigators reported that after PSM analysis, baseline clinical and limb characteristics were similar between patients with and without diabetes. Patients with diabetes had a higher rate of major hematoma (> 4 cm) (9.9% vs 3.3%; P = .038).

At 5-year clinical follow-up, patients with diabetes and patients without diabetes had similar rates of MACE (20.7% vs 20.7%; log rank P = .989) and MALE (19.8% vs 24.5%; log rank P = .312), as well as the individual endpoints.

In subgroup analysis adjusted by PSM, female patients with diabetes had a higher risk of MALE (hazard ratio, 0.31; 95% confidence interval, 0.13–0.69; P = .004).

The investigators concluded that patients with diabetes who underwent endovascular therapy had similar 5-year cardiac and vascular outcomes compared with patients without diabetes, although there was a higher rate of major hematoma. Bleeding avoidance strategies (including optimal antiplatelet and antithrombotic therapy) and meticulous vascular access techniques are needed in patients with diabetes to reduce the risk of bleeding and its deleterious impact on morbidity and mortality, advised the investigators in Vascular Medicine.

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