Abstract
Objectives: Peripheral arterial disease (PAD) in diabetic patients is associated with high morbidity and mortality. The mortality rate in such patients is 56.5% in 3 years follow up period in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. Therefore the incidence and predictive factors to determine the mortality, myocardial infarction, stroke and worsening PAD is of paramount important. Researchers aimed to explore these outcomes in our population.
Method: 500 diabetic patients with being diagnosed as PAD between June 2014 to July 2016, were followed up in 18 months follow up period. Primary end point was major adverse cardiovascular event (MACE), which composed of non fatal myocardial infarction, non fatal stroke, worsening PAD and death. The potential clinical predictors were entered into a Cox proportional hazard model with backward stepwise regression was performed. Researchers also evaluated the adequacy of treatment by assessing the risk factor control for atherosclerosis. The target of the risk factor control for atherosclerosis has been using the criteria of American Heart Association (AHA) and the Royal College of Physicians of Thailand.
Result: During a mean follow-up of 18 months period, 95 MACE events occurred, corresponding to the incidence of 19.0%. The number of death was 43 patients. The predictive factors, that were significantly associated with MACE, were history of chronic kidney disease (hazard ratio (HR) 2.32, 95% confidence interval (95% CI) 1.41-3.80), gangrene or chronic ulcer (HR 3.03, 95%CI 1.82-5.06), history of aortic surgery (HR 24.07, 95%CI 5.28-109.71), patients with history of taking clopidogrel (HR 2.16, 95%CI 1.13-4.12), patients with history of taking warfarin (HR 3.24, 95%CI 1.50-7.02), patients with history of taking sulfonylureas (HR 0.44, 95%CI 0.24-0.83). In terms of risk factor for atherosclerosis management, patients had reach the target in majority (>50%) in the control of diastolic blood pressure (73.10%) and stop smoking (91.83%).
Conclusion: The incidence of MACE was 19%. The predictive factors for high MACE in the first 18 months in diabetic patients with PAD was chronic kidney disease, gangrene or chronic ulcer, history of having aortic surgery, patients with history of taking clopidogrel, patients with history of taking warfarin. This may be used to identify high-risk patients for MACE to assist optimize medical treatment and intensive risk factor control for atherosclerosis to increase life expectancy and to decrease vascular event.
