Document Detail


Advantages of myocardial revascularization after admission for critical limb ischemia in diabetic patients with coronary artery disease: data of a cohort of 564 consecutive patients.
MedLine Citation:
PMID:  18799966     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To evaluate the survival benefit from myocardial revascularization in diabetic patients with critical limb ischemia and coronary artery disease (CAD) in a consecutive series of 564 diabetic patients hospitalized from 1999 to 2003 and followed up until December 2005. METHODS: Three hundred and thirteen patients had a history of CAD, 60 of them (19.2%) with previous myocardial revascularization. Sixty-one patients with an ejection fraction of 40% or less underwent subsequent myocardial revascularization. Five hundred and fifty-seven patients (98.8%) were followed up until December 2005, including 310 of the 313 patients with a history of CAD. RESULTS: One hundred and ten patients died because of CAD, 25 of the 251 patients without a history of CAD and 85 of the 313 patients with a history of CAD. Specifically, 74 (86.9%) of these 85 deaths occurred in the 192 patients without previous myocardial revascularization, nine (10.7%) in the 60 patients with previous myocardial revascularization, and two (2.4%) in the 61 patients in whom myocardial revascularization was performed after hospital admission for critical limb ischemia. The Cox model showed significant hazard ratio for mortality associated with age [hazard ratio 1.06 for 1 year, P = 0.003, confidence interval (CI) 1.02-1.09], history of CAD (hazard ratio 2.16, P < 0.001, CI 1.53-3.06), dialysis (hazard ratio 3.52, P < 0.001, CI 2.08-5.97), and impaired ejection fraction (hazard ratio 1.08 for one point percentage, P < 0.001, CI 1.05-1.09). Myocardial revascularization appeared to have a protective role: hazard ratio 0.29, P < 0.001, CI 0.33-0.93. CONCLUSION: Paying attention to CAD in diabetic patients during their hospitalization for critical limb ischemia is useful for a subsequent myocardial revascularization, and it may increase survival in these patients.
Authors:
Ezio Faglia; Giacomo Clerici; Maurizio Caminiti; Antonella Quarantiello; Vincenzo Curci; Alberto Morabito
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiovascular medicine (Hagerstown, Md.)     Volume:  9     ISSN:  1558-2027     ISO Abbreviation:  J Cardiovasc Med (Hagerstown)     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-18     Completed Date:  2008-10-30     Revised Date:  2009-05-28    
Medline Journal Info:
Nlm Unique ID:  101259752     Medline TA:  J Cardiovasc Med (Hagerstown)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1030-6     Citation Subset:  IM    
Affiliation:
Diabetology Centre-Diabetic Foot Centre, IRCCS Multimedica, Sesto San Giovanni, Italy.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Cohort Studies
Coronary Artery Disease / complications,  mortality,  physiopathology,  surgery*
Critical Illness
Diabetes Complications / mortality,  physiopathology,  surgery*
Dialysis / adverse effects
Female
Humans
Ischemia / complications*,  mortality,  physiopathology,  surgery
Kaplan-Meiers Estimate
Lower Extremity / blood supply*
Male
Middle Aged
Myocardial Revascularization*
Patient Admission*
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Dysfunction / complications,  physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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