JUJO Kentaro    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Assistant Professor
Language	English
Title	Prognostic Impact of Baseline Glycated Hemoglobin Level in Peripheral Artery Disease Patients with and without Hemodialysis
Conference	Japan Endovascular Treatment Conference 2019 (JET2019)
Promoters	Japan Endovascular Treatment Conference (JET)
Conference Type	Nationwide Conferences
Presentation Type	Speech
Publisher and common publisher	◎JUJO Kentaro
Date	2019/02/23
Venue (city and name of the country)	Tokyo, JAPAN
Summary	*Presentation Awards Heat-11 Clinical trials-2 Introduction: Diabetes (DM) is the leading cause of induction of hemodialysis (HD), and both are major prognostic factors in patients with peripheral artery disease (PAD). However, the prognostic importance of baseline glycated hemoglobin (HbA1c) levels in PAD patients with and without HD is yet to be elucidated. Hypothesis: We hypothesized that baseline HbA1c levels had different prognostic impacts after endovascular therapy (EVT) in PAD patients between with and without regular HD. Methods: This observational study included 643 consecutive patients who received EVT between 2013 and 2017. Each of 313 HD patients and 330 Non-HD patients was respectively divided into 2 groups by the comorbidity of diabetes, and DM patients were further divided into 3 subgroups depending on HbA1c level at the time of EVT; DM-Low (HbA1c: -6.0%), DM-Mid (6.1-7.0%), and DM-High (7.1-%) groups. The primary endpoint of this study was major amputation-free survival (AFS). Results:During the observation period after EVT, there were 126 events (19.6%), including 85 deaths and 41 major amputations. Kaplan-Meier analysis revealed that DM patients had a significantly higher AFS rate in HD group (Log-rank: p=0.003, Figure A). In contrast, in Non-HD group, there was no statistical difference in AFS between DM and Non-DM patients (p=0.36). In multivariate Cox regression analysis in HD group, the higher HbA1c-DM group showed the higher hazard ratio (HR) for AFS (p=0.039, Figure B), and DM patients with HbA1c >6.0% had significantly higher HR than Non-DM patients. Whereas, in Non-HD group, HbA1c-DM class adversely associated with HR for AFS (p=0.003), even any classes did not reach statistical differences from Non-DM patients. Conclusions: Comorbidity of diabetes at the time of EVT worsened long-term prognosis in PAD patients receiving regular HD, but not in those without HD. Additionally, baseline HbA1c levels oppositely affected prognosis in PAD patients with and without HD.