title: Tenfold risk increase of major cardiovascular events after high limb amputation with non-compliance for secondary prevention measures.
abstract: Background The aim of the study was to evaluate the impact of compliance with lifestyle recommendations and medication on 1-year prevention of major adverse cardiovascular events (MACE) in patients with type 2 diabetes (T2D) after trans-femoral amputation (TFA). Methods In this prospective single-center interventional cohort study, 179 consecutive T2D patients with symptomatic coronary artery disease (CAD) underwent 1-year follow-up examination after TFA in 2013. Lower limb and coronary artery CT angiography were provided before surgery; physical examination and laboratory tests were performed at baseline and every month after TFA for 1 year. A total of 77 patients (43%) were defined as compliant. They followed all recommendations, including >80% drug intake (anti-diabetic, antihypertensive drugs, dual antiplatelet and statin treatment), healthy diet, smoking cessation, physical exercise ≥30 min/day. A total of 102 patients (57%) were non-compliant (drug intake ≤80%, and did not fully follow lifestyle change recommendations). Results There were no significant differences at baseline between the two groups. Fuster-BEWAT score in 1 year was 9.83 ± 3.1 in compliant and 7.74 ± 2.9 in non-compliant patients ( p = 0.0001). At 1-year follow-up, there were 43 myocardial infarctions (40 patients (93%) were non-compliant) and 28 deaths (26 cases (92.8%) were non-compliant). Patients from the non-compliant group with three- and two-vessel obstructive CAD had higher 1-year MACE rate than those with one-vessel obstructive and non-obstructive CAD (95.24% and 70.5% versus 17.2% and 8.6%; p < 0.0001); more proximal coronary lesions were related to a worse prognosis. Conclusions Non-compliant diabetic patients had a tenfold increased risk for MACE within 1 year after TFA.
authors.affiliation: 1 Tashkent Medical Academy Second Clinic, Republican Centre of Purulent Surgery and Complications of Diabetes, Tashkent, Uzbekistan.
authors.forename: Evgeniya V
authors.initials: EV
authors.lastname: Shalaeva
authors.affiliation: 2 Bern University Hospital, Preventive Cardiology and Sports Medicine, Department of Cardiology, Bern, Switzerland.
authors.forename: Hugo
authors.initials: H
authors.lastname: Saner
authors.affiliation: 1 Tashkent Medical Academy Second Clinic, Republican Centre of Purulent Surgery and Complications of Diabetes, Tashkent, Uzbekistan.
authors.forename: Bakhtiyor B
authors.initials: BB
authors.lastname: Janabaev
authors.affiliation: 1 Tashkent Medical Academy Second Clinic, Republican Centre of Purulent Surgery and Complications of Diabetes, Tashkent, Uzbekistan.
authors.forename: Aleksandra V
authors.initials: AV
authors.lastname: Shalaeva
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000517:prevention & control; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention; D016019:Survival Analysis
keywords: Compliance; cardiovascular disease prevention; low extremity artery disease; major adverse cardiovascular events; secondary prevention; type 2 diabetes