title: Impact of critical limb ischemia on long-term cardiac mortality in diabetic patients undergoing percutaneous coronary revascularization.
abstract: OBJECTIVE
  Development of critical limb ischemia (CLI) has been reported as an independent predictor of cardiac mortality in diabetic patients. We aimed to determine whether CLI, managed in a structured setting of close collaboration between different vascular specialists and treated with early endovascular intervention, has any impact on long-term cardiac mortality of diabetic patients initially presenting with symptomatic coronary artery disease (CAD).
  
  
  METHODS
  We designed a prospective observational study of 764 consecutive diabetic patients undergoing percutaneous coronary intervention (PCI) in whom development of CLI was assessed by a dedicated diabetic foot clinic. Cardiac mortality at 4-year follow-up was the primary end point of the study.
  
  
  RESULTS
  Among the 764 patients, 111 (14%) developed CLI (PCI-CLI group) and underwent revascularization of 145 limbs, with procedural success in 140 (96%). PCI-CLI patients at baseline had lower left ventricular ejection fraction (51 ± 11% vs. 53 ± 10%, P = 0.008), higher prevalence of dialysis (7% vs. 0.3%, P < 0.0001), and longer diabetes duration (13 ± 8 vs. 11 ± 7 years, P = 0.02) compared with PCI-only patients. At 4-year follow-up, cardiac mortality occurred in 10 (9%) PCI-CLI patients vs. 42 (6%) PCI-only patients (P = 0.2). Time-dependent Cox regression model for cardiac death revealed that CLI was not associated with an increased risk of cardiac mortality (hazard ratio 1.08 [95% CI 0.89-3.85]; P = 0.1).
  
  
  CONCLUSIONS
  The development of promptly assessed and aggressively treated CLI was not significantly associated with increased risk of long-term cardiac mortality in diabetic patients initially presenting with symptomatic CAD.
authors: Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy. francescoliistro@hotmail.com
authors: Francesco
authors: F
authors: Liistro
authors: Paolo
authors: P
authors: Angioli
authors: Simone
authors: S
authors: Grotti
authors: Rossella
authors: R
authors: Brandini
authors: Italo
authors: I
authors: Porto
authors: Lucia
authors: L
authors: Ricci
authors: Danilo
authors: D
authors: Tacconi
authors: Kenneth
authors: K
authors: Ducci
authors: Giovanni
authors: G
authors: Falsini
authors: Guido
authors: G
authors: Bellandi
authors: Leonardo
authors: L
authors: Bolognese
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D003920:Diabetes Mellitus / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005121:Extremities / Q000473:pathology*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies