Impact of preprocedural ambulatory status on clinical outcomes after endovascular revascularization in patients with chronic limb-threatening ischemia.

Abstract

It is reported that the preprocedural ambulatory status is an important factor of clinical outcomes after endovascular therapy (EVT) in chronic limb-threatening ischemia (CLTI). However, it is not completely understood the impact of preprocedural ambulatory status on clinical outcomes after EVT in patients with CLTI because there are available scarce papers directly comparing among the subgroups according to preprocedural ambulatory status using the data from the real world. This study aimed to evaluate the outcomes by directly comparing among the subgroups based on preprocedural ambulatory status. We identified 690 consecutive patients with de novo (which means the first episode of CLTI) CLTI treated with EVT between January 2010 and December 2019 at the New Tokyo Hospital in Japan. The study population was divided into two groups: the ambulatory group (n = 356) and the nonambulatory group (n = 334). In addition, each ambulatory and nonambulatory group was divided into additional two groups. The ambulatory group was divided into ambulatory with and without assistance, and the nonambulatory group was divided into wheel chair users and bedridden patients. The primary end point was major adverse limb event (MALE) at 3 years after EVT. MALE was defined as the composite of all-cause death and major lower limb amputation. There was an increased risk of MALE in the nonambulatory group (adjusted hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.89-2.95; P < .001). The worse the preprocedural ambulatory status, the higher the risk of MALE for bedridden patients (adjusted HR, 4.42; 95% CI, 3.03-6.46; P < .001), wheel chair users (adjusted HR, 2.57; 95% CI, 1.92-3.44; P < .001), and ambulatory patients with assistance (adjusted HR, 1.49; 95% CI, 1.07-2.08; P = .008) compared with those without assistance. In patients with CLTI, the worse the preprocedural ambulatory status, the higher the risk of adverse events after EVT for bedridden patients, wheel chair users, and ambulatory patients with assistance compared with those without assistance.