(PC026) SGLT2 inhibitors are not associated with amputation after lower extremity revascularization in patients with diabetes

Objectives: Sodium Glucose Cotransporter-2 inhibitors (SGLT2i) have demonstrated beneficial cardio-renal effects in patients with diabetes. However, there is ongoing concern with their use in patients with peripheral arterial disease (PAD) related to concerns of increased risk of amputation. This study evaluates the use of SGLT2i in patients with diabetes undergoing lower extremity revascularization (LER) for PAD and its impact on amputations.

Methods: A retrospective review of patients with diabetes undergoing LER for PAD from 2013 to 2020 in a tertiary care center was performed. Patients with contraindication to SGLT2i were excluded (chronic kidney disease stage 4/5 and dialysis). Characteristics of patients on SGLT2i at index revascularization were compared to patients not treated with SGLT2i. After 3:1 propensity matching, perioperative and long-term outcomes were compared.

Results: A total of 1,147 patients with diabetes underwent LER for PAD and 204 (17.8%) were treated with SGLT2i. The use of SGLT2i increased significantly from 0 to 10.3% (p < 0.001) over the study period. After excluding patients with contraindications to SGLT2i, 775 patients were analyzed and only 8.5% (n=66) were on SGLT2i prior to index LER. There were significant differences in demographics and comorbidities between the two groups (data not shown). However, after 3:1 propensity matching (N=264), there were no differences in baseline patient or procedural characteristics. Insulin was used in 56.4% of the patients at baseline while 75.8% had documented pre-operative Hemoglobin A1C level (A1C) tested with no difference between the two groups. In the perioperative period, patients with SGLT2i had a higher incidence of return to the OR but there was no difference in morbidity or mortality. There was also no difference in perioperative minor or major amputation (Table). After a mean follow up of 4.3 years, there was no difference on Kaplan Meier analysis between the two groups in major amputation, reintervention, mortality, or the combined endpoint of major adverse limb event (MALE)-free survival (Figure). A1C levels were measured in 84.8% of patient at latest follow up with no difference between the two groups.

Conclusions: SGTL2i use has increased in patients with diabetes undergoing LER. SGLT2i do not seem to be associated with increased major or minor amputation in this patient population.