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Outcomes for Hispanic patients undergoing open bypass in BEST-CLI.
Jesus G Ulloa1, Olamide Alabi2, Katharine McGinigle3
1Division of Vascular and Endovascular Surgery, UCLA, David Geffen School of Medicine, Los Angeles, CA.
Journal of Vascular Surgery
|February 6, 2025
Summary
Hispanic patients did not experience worse limb outcomes after open surgical revascularization for critical limb ischemia. This study found no significant differences in amputation, reintervention, or survival rates compared to non-Hispanic White patients.
Area of Science:
- Vascular Surgery
- Health Disparities
- Clinical Outcomes Research
Background:
- Peripheral artery disease (PAD) disproportionately affects Hispanic populations, often with higher risk factor prevalence.
- Existing data suggest potential disparities in revascularization rates and amputation for Hispanic patients with PAD.
- The Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial provides a robust dataset to investigate these disparities.
Purpose of the Study:
- To compare 1-year limb-related outcomes and survival after open surgical revascularization between Hispanic and non-Hispanic White patients within the BEST-CLI trial.
- To identify if Hispanic ethnicity is independently associated with adverse outcomes following surgical bypass for critical limb ischemia.
Main Methods:
- Secondary analysis of the BEST-CLI trial, focusing on open surgical revascularization cohorts (n=634).
- Outcomes assessed included above-ankle amputation, major reintervention, major adverse limb events, and survival at 1 year.
- Cox regression models were used to adjust for baseline characteristics and assess the association between Hispanic ethnicity and outcomes.
Main Results:
- Hispanic patients (16.7%) were younger and had higher rates of diabetes and end-stage renal disease compared to White patients.
- After multivariable adjustment, Hispanic ethnicity was not significantly associated with major amputation (aHR, 0.67), major reintervention (aHR, 0.81), major adverse limb events (aHR, 0.64), or survival (aHR, 0.69).
Conclusions:
- No significant disparities in limb-related outcomes or survival were observed for Hispanic patients undergoing open revascularization in the BEST-CLI trial.
- Future research should incorporate metrics on access to care and timeliness to better understand potential disparities in PAD management.
- These findings challenge previous assumptions about inherent ethnic disparities in surgical bypass outcomes for PAD.
