Introduction and Objective: The association between preprocedural glycemia and major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs) after endovascular revascularization in diabetic patients with lower extremity arteriosclerosis obliterans (LEASO) remains unclear. The aim of this study is to explore the link between preprocedural glycaemic control and the 1-year risk of MACEs and MALEs after endovascular revascularization in these patients.Methods: This prospective study enrolled 289 diabetic LEASO patients undergoing endovascular revascularization. Using multivariate Cox regression models, we assessed hazard ratios (HRs) between baseline glycemia (HbA1c and fasting plasma glucose [FPG]) and 1-year MACEs/MALEs. Optimal glycemic thresholds for outcome prediction were determined, and corresponding Kaplan-Meier survival curves were generated.Results: In 289 patients, 344 target vessels were successfully opened. Over a mean 1.3-year follow-up, 55 and 68 patients had MACEs and MALEs. Preprocedural HbA1c ≥7.0% increased MACEs risk by 2.1-fold (HR 3.112, 95% CI 1.291-7.502; p=0.011) and amputation or death by 3.56-fold (HR 4.560, 95% CI 1.750-11.884; p=0.002). MALEs risk increased by 13.2% (HR 1.132, 95% CI 1.031-1.244; p=0.01), and all-cause mortality increased by 15.2% (HR 1.152, 95% CI 1.017-1.304; p=0.026) with a 1 mmol/L increase in fasting plasma glucose (FPG) at baseline. For MALEs and all-cause mortality, the optimal preprocedural FPG cut-offs were 7.02 and 6.63 mmol/L, respectively. No significant interactions between preprocedural glycaemic control and various MACEs and MALEs subgroups were observed.Conclusion: Suboptimal preprocedural glycemia in diabetic LEASO patients is associated with elevated risks of MACEs and MALEs at 1 year after endovascular revascularization. Targeting a preprocedural HbA1c <7.0% and FPG <6.63 mmol/L is recommended to improve cardiovascular outcomes in this population.
Q. Zhao: None.
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