Hemoglobin A1C Levels as a Cardiovascular Outcome Measure of Patients with Critical Limb Ischemia Requiring PTFE Tibial/Peroneal Arterial Bypass Grafting Compared to Primary Amputation
Nicholas J. Gargiulo III1, Frank J. Veith2, Evan Lipsitz3, Neal Cayne4, Gregg Landis5.
1Clinch Valley Health, Richlands, VA, USA, 2Cleveland Clinic, Cleveland, OH, USA, 3Montefiore Medical Center, Bronx, NY, USA, 4NYU, NY, NY, USA, 5Northwell Health, NY, NY, USA.
Objective: Diabetes Mellitus is a known risk factor in the development of peripheral arterial disease. Hemoglobin A1C (HbA1C) may be used to predict cardiovascular risk. We hypothesize that HbA1C levels predict cardiovascular outcome in a cohort of patients undergoing PTFE tibial/peroneal arterial bypass grafting.
Methods: A retrospective review of all patients presenting with limb threatening ischemia between June 1977 to January 2017 was conducted. All patients underwent conventional arteriography prior to intervention. In this cohort of 23,391 patients, 443 patients underwent PTFE grafting and 103 patients underwent primary amputation. Hemoglobin A1C levels were performed within 3 months of presentation. Patients were placed into high (>7) and low (<7) hemoglobin A1C groups and data was collected on type of presentation, comorbidities, anatomic level of disease, tibial artery patency, need for amputation, contralateral disease, need for an open vs. an endovascular procedure, and freedom from intervention. Fisher's exact t test was used to compare the two groups. A P value <0.05 was considered statistically significant.
Results: In the PTFE cohort, 227 patients had HbA1C levels above 7.0 and in the primary amputation cohort 77 patients had levels above 7.0 (mean 7.7 ± 2.3, range 5.1 to 17.3). There were no statistically significant differences in the two groups in comorbities, average age, initial gangrene at presentation, aspirin or statin use, or smoking status. Patients in the >7.0 HbA1C group had similar 30-day and 1 year MI, stroke, death and readmission rate as compared to the < 7.0 HbA1C group in both the PTFE and primary amputation cohort. Conclusions: Elevated hemoglobin A1C does not appear to affect 30 day and 1 year cardiovascular outcome in both PTFE bypass and primary amputation patients. This suggests other factors related to diabetes mellitus may contribute to these observations.
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