Medial arterial calcification of the foot arteries is associated with incident cardiovascular events or all-cause mortality in patients with diabetes-related foot ulceration

AIMS: Pedal medial arterial calcification (pMAC) is a marker of vascular pathology incidentally detected on foot x-ray. We assessed the association between pMAC and major adverse cardiovascular events (MACE) and mortality in patients with diabetes-related foot ulceration (DFU). METHODS: A retrospective study of adults with DFU was performed. pMAC was assessed at five sites on foot x-ray and graded as no/low, moderate or severe. Incident MACE was defined as hospitalisation for myocardial infarction, heart failure, stroke or transient ischaemic attack. RESULTS: Of 509 patients, 55.2%, 23.4% and 21.4% had no/low, moderate and severe pMAC, respectively. Median follow-up was 531 days (interquartile range 288-793). pMAC was associated with higher MACE or all-cause mortality (no/low 18.1% versus moderate 26.9% versus severe 42.2%; log-rank p < 0.001) and MACE (no/low 11.4% versus moderate 19.3% versus severe 19.3%; log-rank p = 0.020). In multivariable analysis, pMAC was associated with MACE or all-cause mortality (p = 0.009), but not MACE (p = 0.299). MACE was highest in patients with both pMAC and infected ulcers (25.0%), compared with pMAC only (12.5%), infection only (14.0%) and neither (9.0%) (log-rank p < 0.001), remaining significant after adjustment (p = 0.017). CONCLUSIONS: pMAC is associated with MACE or all-cause mortality in patients with DFU, with infected ulcers heightening the risk of MACE.