Treatment for diabetic foot ulcers complicated by major cardiac events.
OBJECTIVE
Diabetic foot ulcer (DFU) is a major complication in patients with diabetes mellitus and the leading cause of non-traumatic amputation in adults. Patients with DFU are usually fragile due to chronic diabetic comorbidities; therefore, tedious debridement and intervention procedures may not be well tolerated in patients with DFU. This study aimed to identify a casual relationship between in-hospital complications and treatment for limb-threatening DFUs.


METHODS
From 2009 to 2011, 1130 consecutive patients who were admitted to the Diabetic Foot Care Center in Chang Gung Medical Center were surveyed. Rates of in-hospital mortality or events that lead to transfer to the intensive care unit (ICU) for various severe complications were retrospectively analyzed.


RESULTS
Forty-seven patients (4.2%) experienced in-hospital complications (28 patients died). Major adverse cardiac events (MACE) (n=21, 44.7%) were the most common complications, followed by nosocomial infection (n=18, 38.3%). Previous myocardial infarction was a risk factor for MACE. The presentation of MACE was fulminant (eg, acute pulmonary edema, cardiogenic shock,cardiac arrest), and occurred within 10 days of admission or within 10 days following a major procedure in most cases. ST-T segment abnormality at rest was the most common presentation of electrocardiography for MACE.


CONCLUSIONS
MACE should be prevented during treatment for limb-threatening DFU in high-risk patients. Acute stress might have caused MACE during the first 10 days after admission or a major procedure.
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Shih-Yuan
SY
Hung
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Yu-Yao
YY
Huang
Division of Cardiology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Lung-An
LA
Hsu
Division of Cardiology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Chun-Chi
CC
Chen
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Hui-Mei
HM
Yang
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Jui-Hung
JH
Sun
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Cheng-Wei
CW
Lin
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan. Electronic address: P122020223@cgmh.org.tw.
Chih-Ching
CC
Wang
D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000150:complications / Q000401:mortality; D003646:Debridement / Q000379:methods; D017719:Diabetic Foot / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000150:complications* / Q000401:mortality; D013315:Stress, Psychological / Q000150:complications; D013624:Taiwan; D016896:Treatment Outcome
In-hospital complication; MACE; NSTEMI; complication à l'hôpital; diabetic foot ulcer; ulcère du pied diabétique; évènements indésirables cardiaques majeurs