Cardiovascular Impact of Endovascular Revascularization in Chronic Limb-Threatening Ischemia Versus Claudication: A
Sultana Jahan1, Ali Awad2, Mustafa Al-Mollah3
1Department of Medicine, Valley Health System, Las Vegas, Nevada.
Insights
Patients with chronic limb-threatening ischemia (CLTI) face worse cardiovascular outcomes after endovascular repair than those with claudication. This highlights the need for enhanced risk management in high-risk CLTI patients post-intervention.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Interventional Cardiology
Background:
- Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease.
- Long-term cardiovascular outcomes post-endovascular revascularization for CLTI versus claudication are not well-defined.
Purpose of the Study:
- To compare long-term cardiovascular outcomes between patients with CLTI and intermittent claudication undergoing endovascular lower-extremity revascularization.
- To identify risks associated with CLTI in the context of peripheral artery disease interventions.
Main Methods:
- Utilized the TriNetX global research network, including 114 health care organizations.
- Identified adults undergoing endovascular lower-extremity revascularization for CLTI or claudication.
- Employed propensity score matching for 3727 pairs based on demographics, comorbidities, and medications; assessed major adverse cardiovascular events and secondary outcomes at 1, 3, and 5 years.
Main Results:
- At 5 years, CLTI patients had higher risks of major adverse cardiovascular events (34.9% vs 30.7%), all-cause mortality (18.7% vs 15.6%), heart failure hospitalization (15.0% vs 13.0%), major bleeding (15.1% vs 13.3%), and acute kidney injury (26.4% vs 22.2%) compared to claudication patients.
- Stroke or transient ischemic attack rates were similar; repeat revascularization was lower in CLTI patients (45.9% vs 51.2%).
- Findings were consistent at 1- and 3-year follow-ups.
Conclusions:
- Endovascular revascularization for CLTI is associated with significantly worse short- and long-term cardiovascular outcomes compared to claudication.
- Intensified cardiovascular risk stratification and secondary prevention are crucial for high-risk CLTI patients post-peripheral intervention.
Background:
Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease, yet long-term cardiovascular outcomes after endovascular revascularization compared with claudication remain poorly defined.
Methods:
Using the TriNetX global research network (114 health care organizations), adults undergoing endovascular lower-extremity revascularization for CLTI or intermittent claudication were identified. Propensity score matching for demographics, comorbidities, and cardiovascular medications yielded 3727 matched pairs. Major adverse cardiovascular events (all-cause mortality, myocardial infarction, or stroke) and secondary outcomes were assessed at 1, 3, and 5 years.
Results:
At 5 years, patients with CLTI experienced a significantly higher risk of major adverse cardiovascular events compared with those with claudication (34.9% vs 30.7%; P < .001), along with greater all-cause mortality (18.7% vs 15.6%; P < .001), heart failure hospitalization (15.0% vs 13.0%; P = .001), major bleeding (15.1% vs 13.3%; P = .002), and acute kidney injury (26.4% vs 22.2%; P < .001). Rates of stroke or transient ischemic attack were similar between groups, whereas repeat revascularization was lower among patients with CLTI (45.9% vs 51.2%; P = .002). These findings were consistent at 1- and 3-year follow-up.
Conclusions:
Chronic limb-threatening ischemia patients undergoing endovascular revascularization experience significantly worse short- and long-term cardiovascular outcomes compared with claudication, underscoring the need for intensified cardiovascular risk stratification and secondary prevention in this high-risk population following peripheral intervention.
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