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Retrospective review of superficial femoral artery stenting in diabetic patients: thiazolidinedione use may decrease reinterventions.

Walker KL, Walsh DB, Goodney PP, Connell SA, Stone DH, Powell RJ, Rzucidlo EM - BMC Cardiovasc Disord (2014)

Bottom Line: This pilot, translation study demonstrates that diabetic patients taking thiazolidinediones at the time of primary SFA stenting have decreased reintervention rates at 2 years.These results may be explained by higher adiponectin levels or other anti-inflammatory effects in patients taking thiazolidinedione.National and regional quality improvement registries should consider collecting information regarding specific diabetic regimens and use of PPAR agonists such as cilostazol and fibrates.

View Article: PubMed Central - PubMed

Affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA. eva.m.rzucidlo@hitchcock.org.

ABSTRACT

Background: Diabetics are known to have inferior outcomes following peripheral vascular interventions. Thiazolidinediones are oral diabetic agents which improve outcomes following coronary bare metal stenting. No studies have been performed evaluating thiazolidinedione use and outcomes following lower extremity endovascular interventions. We hypothesize that diabetic patients taking thiazolidinediones at the time of primary superficial femoral artery (SFA) stenting have fewer reinterventions.

Methods: A retrospective review was performed to identify diabetic patients undergoing primary SFA stenting. The unit of analysis was the extremity. The primary outcome was freedom from target lesion revascularization stratified by thiazolidinedione use, evaluated by Kaplan Meier curves and a log rank test. A Cox proportional hazards model was constructed to determine variables associated with freedom from target lesion revascularization.

Results: SFA stents were placed in 138 extremities in 128 diabetic patients between August 1, 2001 and July 15, 2012. Twenty-four patients were taking thiazolidinediones at the time of SFA stenting. All patients taking thiazolidinediones had TASC A or B lesions. Twenty-seven extremities in the non-thiazolidinedione group had TASC C or D lesions and were excluded to control for disease severity. Freedom from target lesion revascularization was significantly higher in diabetics taking thiazolidinediones at 2 years, 88.5% vs. 59.4%, P = 0.02, SE < 10%. Cox modeling identified a protective trend for thiazolidinedione use (thiazolidinedione use HR 0.33, 95% CI 0.09-1.13), whereas critical limb ischemia and insulin use were associated with trends for worse freedom from target lesion revascularization.

Conclusions: This pilot, translation study demonstrates that diabetic patients taking thiazolidinediones at the time of primary SFA stenting have decreased reintervention rates at 2 years. These results may be explained by higher adiponectin levels or other anti-inflammatory effects in patients taking thiazolidinedione. National and regional quality improvement registries should consider collecting information regarding specific diabetic regimens and use of PPAR agonists such as cilostazol and fibrates.

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Freedom from SFA Stent TLR among diabetics with TASC A or B Lesions by TZD use. Freedom from TLR was 88.5% % for diabetics with TASC A or B lesions taking TZDs at the time of SFA stenting vs. 59.5% for those not taking a TZDs at 2 years. This difference was statistically significant, P = 0.02, with a standard error < 10% at all points on the graph.
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Fig3: Freedom from SFA Stent TLR among diabetics with TASC A or B Lesions by TZD use. Freedom from TLR was 88.5% % for diabetics with TASC A or B lesions taking TZDs at the time of SFA stenting vs. 59.5% for those not taking a TZDs at 2 years. This difference was statistically significant, P = 0.02, with a standard error < 10% at all points on the graph.

Mentions: To address the concern that disease severity was different for those patients taking TZDs vs. those patients not taking TZDs, we performed a second analysis limited to diabetic patients with TASC A and B lesions (Figure 1). This analysis excluded 27 patients with TASC C and D lesions who were not taking TZDs; therefore, 87 patients not taking TZDs and 24 patients taking TZDs were included in the cohort. Demographics, comorbidities, use of cardiovascular medications, and use of diabetic medications were similar for patients with TASC A and B lesions regardless of TZD use. However, the prevalence of CLI still remained lower for patients taking TZDs (Table 2). The mean stented vessel diameter was 5.4 mm (95% CI: 5.2-5.5 mm) for patients not taking TZDs vs. 5.5 mm (95% CI: 5.2-5.8 mm) for patients taking TZDs, p = 0.37. The mean stented length was 12.7 cm (95% CI: 11.0-14.3 cm) for patients not taking TZDs vs. 8.9 cm (95% CI: 6.6-11.2 cm) for patients taking TZDs, p = 0.02. Despite the exclusion of TASC C and D lesions, the association of TZD use with improved freedom from TLR remained: patients with a TASC A or B lesion taking a TZD at the time of SFA stenting had a significantly better outcome with 88.5% vs. 59.5% being free from TLR at 2 years, P = 0.02 (Figure 3).Table 2


Retrospective review of superficial femoral artery stenting in diabetic patients: thiazolidinedione use may decrease reinterventions.

Walker KL, Walsh DB, Goodney PP, Connell SA, Stone DH, Powell RJ, Rzucidlo EM - BMC Cardiovasc Disord (2014)

Freedom from SFA Stent TLR among diabetics with TASC A or B Lesions by TZD use. Freedom from TLR was 88.5% % for diabetics with TASC A or B lesions taking TZDs at the time of SFA stenting vs. 59.5% for those not taking a TZDs at 2 years. This difference was statistically significant, P = 0.02, with a standard error < 10% at all points on the graph.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4269962&req=5

Fig3: Freedom from SFA Stent TLR among diabetics with TASC A or B Lesions by TZD use. Freedom from TLR was 88.5% % for diabetics with TASC A or B lesions taking TZDs at the time of SFA stenting vs. 59.5% for those not taking a TZDs at 2 years. This difference was statistically significant, P = 0.02, with a standard error < 10% at all points on the graph.
Mentions: To address the concern that disease severity was different for those patients taking TZDs vs. those patients not taking TZDs, we performed a second analysis limited to diabetic patients with TASC A and B lesions (Figure 1). This analysis excluded 27 patients with TASC C and D lesions who were not taking TZDs; therefore, 87 patients not taking TZDs and 24 patients taking TZDs were included in the cohort. Demographics, comorbidities, use of cardiovascular medications, and use of diabetic medications were similar for patients with TASC A and B lesions regardless of TZD use. However, the prevalence of CLI still remained lower for patients taking TZDs (Table 2). The mean stented vessel diameter was 5.4 mm (95% CI: 5.2-5.5 mm) for patients not taking TZDs vs. 5.5 mm (95% CI: 5.2-5.8 mm) for patients taking TZDs, p = 0.37. The mean stented length was 12.7 cm (95% CI: 11.0-14.3 cm) for patients not taking TZDs vs. 8.9 cm (95% CI: 6.6-11.2 cm) for patients taking TZDs, p = 0.02. Despite the exclusion of TASC C and D lesions, the association of TZD use with improved freedom from TLR remained: patients with a TASC A or B lesion taking a TZD at the time of SFA stenting had a significantly better outcome with 88.5% vs. 59.5% being free from TLR at 2 years, P = 0.02 (Figure 3).Table 2

Bottom Line: This pilot, translation study demonstrates that diabetic patients taking thiazolidinediones at the time of primary SFA stenting have decreased reintervention rates at 2 years.These results may be explained by higher adiponectin levels or other anti-inflammatory effects in patients taking thiazolidinedione.National and regional quality improvement registries should consider collecting information regarding specific diabetic regimens and use of PPAR agonists such as cilostazol and fibrates.

View Article: PubMed Central - PubMed

Affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA. eva.m.rzucidlo@hitchcock.org.

ABSTRACT

Background: Diabetics are known to have inferior outcomes following peripheral vascular interventions. Thiazolidinediones are oral diabetic agents which improve outcomes following coronary bare metal stenting. No studies have been performed evaluating thiazolidinedione use and outcomes following lower extremity endovascular interventions. We hypothesize that diabetic patients taking thiazolidinediones at the time of primary superficial femoral artery (SFA) stenting have fewer reinterventions.

Methods: A retrospective review was performed to identify diabetic patients undergoing primary SFA stenting. The unit of analysis was the extremity. The primary outcome was freedom from target lesion revascularization stratified by thiazolidinedione use, evaluated by Kaplan Meier curves and a log rank test. A Cox proportional hazards model was constructed to determine variables associated with freedom from target lesion revascularization.

Results: SFA stents were placed in 138 extremities in 128 diabetic patients between August 1, 2001 and July 15, 2012. Twenty-four patients were taking thiazolidinediones at the time of SFA stenting. All patients taking thiazolidinediones had TASC A or B lesions. Twenty-seven extremities in the non-thiazolidinedione group had TASC C or D lesions and were excluded to control for disease severity. Freedom from target lesion revascularization was significantly higher in diabetics taking thiazolidinediones at 2 years, 88.5% vs. 59.4%, P = 0.02, SE < 10%. Cox modeling identified a protective trend for thiazolidinedione use (thiazolidinedione use HR 0.33, 95% CI 0.09-1.13), whereas critical limb ischemia and insulin use were associated with trends for worse freedom from target lesion revascularization.

Conclusions: This pilot, translation study demonstrates that diabetic patients taking thiazolidinediones at the time of primary SFA stenting have decreased reintervention rates at 2 years. These results may be explained by higher adiponectin levels or other anti-inflammatory effects in patients taking thiazolidinedione. National and regional quality improvement registries should consider collecting information regarding specific diabetic regimens and use of PPAR agonists such as cilostazol and fibrates.

Show MeSH
Related in: MedlinePlus