ナカオ マサシ
  中尾 優
   所属   医学部 医学科(東京女子医科大学病院)
   職種   助教
言語種別 日本語
発表タイトル Prognostic Impact of Baseline Glycohemoglobin Level in Peripheral Artery DiseasePatients with and without Hemodialysis
会議名 第67回日本心臓病学会学術集会
主催者 日本心臓病学会
学会区分 全国規模の学会
発表形式 口頭
講演区分 シンポジウム・ワークショップ パネル(公募)
発表者・共同発表者◎重城健太郎, 溝渕景子, 石田一世, 南雄一郎, 春木伸太郎, 沼田まどか, 中尾優, 萩原誠久
発表年月日 2019/09/13
開催地
(都市, 国名)
名古屋市
概要 *シンポジウム 4
糖尿病患者の心血管イベント予防

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 still unclear.

Methods:This observational study included 643 consecutive patients who received endovascular therapy (EVT). Each of 313 HD and 330 Non-HD patients was respectively divided into 2 groups by the comorbidity of DM, 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: DM patients had a significantly higher AFS rate in HD group (Log-rank: p=0.003). 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, 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, even any classes did not reach statistical differences from Non-DM patients.

Conclusions: Comorbidity of DM 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.