Factors associated with all-cause mortality in endovascularly treated patients with diabetes mellitus and lower extremity peripheral arterial disease.

Abstract

Background: This study aimed to examine 5-year all-cause mortality in endovascularly treated patients with peripheral arterial disease of the lower extremities with and without diabetes mellitus (DM), and to identify factors associated with mortality in the DM subgroup. Patients and methods: Patients treated between January 2016 and December 2018 were analysed. Multivariable models were adjusted for age, sex, smoking, chronic limb-threatening ischaemia (CLTI), malignancy, dyslipoproteinaemia, heart failure, fibrinogen, and estimated glomerular filtration rate (eGFR). Results: A total of 676 patients were included; 59.6% had DM. Patients with DM had higher mortality compared to those without DM (56.8% vs. 37.0%, p < .001). DM was associated with higher mortality in univariable analysis (hazard ratio (HR) 1.73; p < .001), but not in multivariable analysis (HR 1.19; p = .329). Among patients with DM, higher mortality was associated with CLTI (HR 1.62; p = .022), and treatment of two or three anatomical regions (HR 1.36; p = .033). Higher fibrinogen (HR 1.17 per 1 g/L; p < .001) and lower eGFR (HR 0.98 per 1 ml/min/1.73 m²; p < .001) were associated with increased mortality. Mortality was lower in patients who underwent ipsilateral reintervention (HR 0.61; p = .005), amputation (HR 0.65; p = .011), or contralateral intervention (HR 0.58; p = .004). Conclusions: Mortality did not differ between patients with and without DM after multivariable adjustment. In patients with DM, CLTI, multiregional treatment, higher fibrinogen, and lower eGFR were associated with increased mortality; ipsilateral reintervention, amputation, and contralateral intervention were linked to lower mortality.