Advantages of myocardial revascularization after admission for critical limb ischemia in diabetic patients with coronary artery disease: Data of a cohort of 564 consecutive patients

Ezio Faglia, Giacomo Clerici, Maurizio Caminiti, Antonella Quarantiello, Vincenzo Curci, Alberto Morabito

Research output: Contribution to journalArticle

Abstract

Aim: To evaluate the survival benefit from myocardial revascularization in diabetic patients with critical limb ischemia and coronary artery disease (CAD) in a consecutive series of 564 diabetic patients hospitalized from 1999 to 2003 and followed up until December 2005. Methods: Three hundred and thirteen patients had a history of CAD, 60 of them (19.2%) with previous myocardial revascularization. Sixty-one patients with an ejection fraction of 40% or less underwent subsequent myocardial revascularization. Five hundred and fifty-seven patients (98.8%) were followed up until December 2005, including 310 of the 313 patients with a history of CAD. Results: One hundred and ten patients died because of CAD, 25 of the 251 patients without a history of CAD and 85 of the 313 patients with a history of CAD. Specifically, 74 (86.9%) of these 85 deaths occurred in the 192 patients without previous myocardial revascularization, nine (10.7%) in the 60 patients with previous myocardial revascularization, and two (2.4%) in the 61 patients in whom myocardial revascularization was performed after hospital admission for critical limb ischemia. The Cox model showed significant hazard ratio for mortality associated with age [hazard ratio 1.06 for 1 year, P = 0.003, confidence interval (CI) 1.02-1.09], history of CAD (hazard ratio 2.16, P <0.001, CI 1.53-3.06), dialysis (hazard ratio 3.52, P <0.001, CI 2.08-5.97), and impaired ejection fraction (hazard ratio 1.08 for one point percentage, P <0.001, CI 1.05-1.09). Myocardial revascularization appeared to have a protective role: hazard ratio 0.29, P <0.001, CI 0.33-0.93. Conclusion: Paying attention to CAD in diabetic patients during their hospitalization for critical limb ischemia is useful for a subsequent myocardial revascularization, and it may increase survival in these patients.

Original languageEnglish
Pages (from-to)1030-1036
Number of pages7
JournalJournal of Cardiovascular Medicine
Volume9
Issue number10
DOIs
Publication statusPublished - Oct 2008

Keywords

  • Coronary artery disease
  • Critical limb ischemia
  • Diabetes
  • Myocardial
  • Revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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