Coronary artery calcium score and coronary computed tomography angiography predict one-year mortality in patients with type 2 diabetes and peripheral artery disease undergoing partial foot amputation

Abstract

The aim of the study was to examine the predictive value of coronary computed tomographic angiography (CCTA) and coronary artery calcium score (CACS) on 1-year all-cause mortality in type 2 diabetes (T2D) patients with peripheral artery disease (PAD) undergoing partial foot amputations (PFA). Methods This is a single-center prospective cohort study including 199 consecutive patients with T2D, PAD (mean age 62.3 ± 7.2 years; 62.8% males), and preoperative CACS and CCTA undergoing PFA and followed-up over 1 year. Results Over a period of 1 year follow-up, a total of 35 (17.6%) participants died. The area under ROC curve to predict mortality for the CACS was 0.835 (95% CI:0.769–0.900), for CCTA 0.858 (95% CI:0.788–0.927). After adjustment for confounders, compared to no-stenosis on CCTA (reference), the risk of all-cause mortality in non-obstructive coronary atery disease (CAD) increased (HR = 1.38, 95% CI [0.75–12.86], p = .284), 1-vessel obstructive CAD (HR = 8.13, 95% CI [0.87–75.88], p = .066), 2-vessels (HR = 10.94, 95% CI [1.03–115.8], p = .047), and 3-vessels (HR = 45.73, 95% CI [4.6–454.7], p = .001) respectively. Increasing levels of CACS tended to be associated with increased risk of all-cause mortality (HR = 1.002, 95% CI [1.0–1.003], p = .061). 61/95 patients with obstructive CAD underwent coronary revascularization. Conclusions Coronary artery calcium score and CCTA have a high predictive value for 1-year all-cause mortality in T2D patients undergoing minor amputations and may be considered for preoperative risk assessment allowing timely preventive interventions.