Patients with critical limb ischemia (CLI) undergoing peripheral vascular intervention (PVI) may be more likely to experience in-hospital major adverse cardiovascular and limb events, according to a review letter published Feb. 10 in the Journal of the American College of Cardiology.

Jennifer A. Rymer, MD, MBA, et al., used data from ACC's PVI Registry to compare in-hospital major adverse cardiovascular events (MACE) and in-hospital major adverse limb events (MALE) among patients with CLI vs. claudication undergoing PVI. MACE was defined as the composite of all-cause death, myocardial infarction, stroke or transient ischemic attack, while MALE was defined as emergency vascular surgery, all-cause amputation, other vascular complications requiring treatment or compartment syndrome. The researchers also examined the proportion of patients with CLI vs. claudication who received guideline-directed medical therapy at discharge.

Of 27,621 patients undergoing PVI, 12,558 (45.5%) had CLI and 15,063 (54.5%) had claudication. Patients with CLI were more likely to have diabetes, end-stage renal disease or a history of heart failure. Patients with CLI were more likely than those with claudication to experience both MACE (1.37% vs. 0.26%) and MALE (1.56% vs. 0.69%). At discharge, patients with CLI were less likely than those with claudication to receive guideline-directed medical therapy, including aspirin, P2Y12 inhibitors, angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker, and statins.

According to the researchers, the findings show that patients with CLI are more likely to experience in-hospital MACE and MALE and demonstrate underutilization of guideline-directed medical therapy in these patients. They conclude that national quality improvement efforts around PVI are necessary to improve care for CLI patient population.

Clinical Topics: Heart Failure and Cardiomyopathies, Vascular Medicine, Acute Heart Failure

Keywords: Ischemic Attack, Transient, Quality Improvement, Stroke, Intermittent Claudication, Myocardial Infarction, Angiotensin-Converting Enzyme Inhibitors, Registries, National Cardiovascular Data Registries, PVI Registry, Heart Failure, Diabetes Mellitus, Kidney Failure, Chronic, Angiotensin Receptor Antagonists

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