Influence of preprocedural glycemic control on clinical outcomes of endovascular therapy in diabetic patients with lower extremity artery disease: an analysis from a Korean multicenter retrospective registry cohort
Authors: Cha Jung-Joon , Kim Hyoeun , Ko Young-Guk , Choi Donghoon , Lee Jae-Hwan , Yoon Chang-Hwan , Chae In-Ho , Yu Cheol Woong , Lee Seung Whan , Lee Sang-Rok , Choi Seung Hyuk , Koh Yoon Seok , Min Pil-Ki ,   K-VIS (Korean Vascular Intervention Society) investigators, Kang Woong Chol , Her Sung-Ho , Koh Yoon Seok , Hwang Byung-Hee , Hwang Byung-Hee , Her Ae-Young , Kim Weon , Yu Cheol Woong , Jo Sang Cheol , Jo Sang Cheol , Shin Sanghoon , Cho Yun Hyeong , Chung Woo-Young , Chae In-Ho , Yoon Chang-Hwan , Han Jung Kyu , Lee Seung Whan , Choi Seung Hyuk , Choi Young Jin , Kim Su Hyun , Park Sang Ho , Min Pil-Ki , Choi Donghoon , Ko Young-Guk , Yoon Young Jin , Lee Jung-Hee , Choi Yu Jeong , Ryu Sung Kee , Kim Ju Han , Lee Sang-Rok , Won Hoyoun , Baek Ju Yeol , Lee Jae-Hwan , Bae Jang-Hwan , Kim Hyun-Sook 
Published: June 2020

Abstract
Background
The influence of intensive glucose control in diabetic patients on the macrovascular outcomes is controversial. Thus, this study aimed to elucidate the effect of preprocedural hemoglobin A1c (HbA1c) on clinical outcomes after endovascular therapy for lower extremity artery disease (LEAD) in diabetic patients.

Methods
Diabetic patients were enrolled from the retrospective cohorts of a Korean multicenter endovascular therapy registry and were divided according to the HbA1c level during index admission into the optimal (< 7.0%) or suboptimal (≥ 7.0%) glycemic control groups. The primary endpoints were major adverse limb events (MALE, a composite of major amputation, minor amputation, and reintervention).

Results
Of the 1103 patients enrolled (897 men, mean age 68.2 ± 8.9 years), 432 (39.2%) were classified into the optimal glycemic control group and 671 (60.8%) into the suboptimal glycemic control group. In-hospital events and immediate procedural complications were not different between the two groups. The suboptimal group showed a trend towards a higher incidence of MALE than the optimal group (log-rank p = 0.072). Although no significant differences were found between the two groups in terms of overall survival or amputation, the risk of reintervention was significantly higher in the suboptimal group (log-rank p = 0.048). In the multivariate Cox regression model, suboptimal glycemic control was one of the independent predictors for reintervention. When our data were analyzed according to the initial presentation, suboptimal preprocedural HbA1c significantly increased the incidence of MALE compared with optimal preprocedural HbA1c only in patients with intermittent claudication.

Conclusion
In diabetic patients undergoing endovascular therapy for LEAD, suboptimal preprocedural HbA1c is associated with an increased risk of adverse limb events, especially in patients with intermittent claudication. Further prospective research will be required to validate the role of more intensive glycemic control on the reduction of adverse limb events in diabetic patients undergoing endovascular therapy for LEAD.