Pre-operative Cilostazol in Patients with Chronic Limb Threatening Ischaemia Associated with Improved Survival after Endovascular Revascularisation.

Abstract

The study aimed to assess the effect of pre-operative cilostazol on long term survival and peri-operative outcomes in patients with chronic limb threatening ischaemia (CLTI) undergoing endovascular therapy (EVT). This retrospective cohort study used the Vascular Quality Initiative registry, including a propensity score adjusted cohort of patients who underwent elective peripheral vascular interventions between 2015 and 2021. Patients were categorised based on pre-operative cilostazol use: cilostazol (PC) group and no cilostazol (NPC) group. The primary outcome was long term (five years) all cause mortality, with secondary outcomes including peri-operative amputation, cardiac complications, and thrombotic or embolic events. There were 55 457 patients in the NPC group and 3 173 patients in the PC group who underwent EVT and were included in the final cohort. The PC group showed statistically significantly higher long term survival than the NPC group (hazard ratio 0.56, 95% confidence interval [CI] 0.5 - 0.6; p < .001) over a follow up period of five years. The PC group also demonstrated lower rates of peri-operative amputation compared with the NPC group (odds ratio 0.69, 95% CI 0.6 - 0.8; p < .001). No other differences were found for peri-operative outcomes between groups. Pre-operative cilostazol use in patients with CLTI undergoing EVT was associated with improved long-term survival and reduced peri-operative amputation rates. These findings suggest a potential benefit of cilostazol in this high-risk population, justifying further dedicated, prospective studies.