CORONARY-ARTERY DISEASE IN DIABETIC AND NONDIABETIC PATIENTS WITH LOWER-EXTREMITY ARTERIAL-DISEASE - A REPORT FROM THE CORONARY-ARTERY-SURGERY-STUDY-REGISTRY

Objective Patients with lower extremity arterial disease (LEAD) are at an increased risk of having coronary artery disease (CAD). Diabetics are at especially high risk for having LEAD with concomitant CAD. This study was undertaken (1) to define the clinical and arteriographic fe atures associated with CAD among diabetics and nondiabetics with LEAD and (2) to determine the long-term survival and predictors of mortalit y of diabetics and nondiabetics with LEAD and CAD. Research Design and Methods Two hundred sixty-three diabetics and 1137 nondiabetics from the Coronary Artery Surgery Study who had evidence of LEAD, who were 5 0 years and older, and who had arteriographically proven CAD were moni tored For a mean of 12.8 years. Results Among all the subjects with LE AD there was a high prevalence of current and post smoking, history of previous myocardial infarction, systemic hypertension, congestive hea rt failure, high degrees of angina pectoris and unstable angina pector is, and use of beta-blockers. On arteriographic evaluation a high prev alence of three-vessel epicardial coronary disease and involvement of multiple coronary segments with greater than or equal to 50% diameter narrowing was found. Multivariate analysis showed the number of corona ry segments with greater than or equal to 50% occlusion, the presence of cerebrovascular disease, the use of digitalis, and elevated systoli c blood pressure were independently associated with diabetes. On follo w-up diabetics had a significantly higher mortality rate (mostly cardi ac) than nondiabetics: median survival, 8.1 years and 12.7 years, resp ectively. At 15 years the mortality rates were 77.1% and 62.0%, respec tively. On multivariate analysis, age, number of coronary occlusions, number of significantly narrowed epicardial arteries, diminished myoca rdial contractility, hypertension, and smoking were significant predic tors of mortality in the total group and in each subgroup. Coronary ar tery bypass grafting surgery was protective. The presence of diabetes was an independent risk factor for mortality Conclusions The presence of LEAD is associated with multivessel epicardial and multiple coronar y segment occlusion. On long-term follow-up there is a high mortality rate. In patients with LEAD and diabetes, CAD is especially severe and prognosis is poor.