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 major adverse cardiovascular event (MACE), which composed of non-fatal myocardial infarction, non-fatal stroke, worsening PAD and death is of paramount important. Researchers aimed to explore these outcomes in our population. Method: 500 diabetic patients with being diagnosed as PAD between May 2014 to February 2017, were followed up in 30 months to determine MACE. 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 30 months period, 81 MACE events occurred, corresponding to incidence rate 16.20, (95%CI 13.10-19.70). The number of death was 59 patients. The predictive factors, that were significantly associated with MACE, were history of chronic kidney disease (Hazard ratio (HR) 2.09, 95% confidence interval (95% CI) 1.24-3.52), myocardial infarction (HR 1.98, 95% CI 1.06-3.71), the history of gangrene or chronic ulcer or obtaining of revascularization in the legs (CLI) (HR 2.50, 95%CI 1.53-4.08), history of aortic surgery (HR 20.31, 95%CI 4.49-91.82), history of carotid stenting (HR 9.20, 95%CI 1.13-74.71), patients with history of taking warfarin (HR 2.83, 95%CI 1.19-6.72). In terms of risk factor control for atherosclerosis management, patients had reach the target in majority (>50%) only in the control of diastolic blood pressure (71.93%) and stop smoking (92.26%). Conclusion: The incidence of MACE was 16.2%. The predictive factors for high MACE in the 30 months follow up in diabetic patients with PAD was chronic kidney disease, myocardial infarction, history of CLI or history of obtaining revascularisation, history of aortic surgery, history of carotid stenting, patients with history of taking warfarin. This may be used to identify high-risk patients for MACE to assist optimize medical treatment to increase life expectancy and to decrease vascular event. There were still a large gap of improvement for risk factor control in atherosclerosis management.
