Critical Limb Threatening Ischemia And Adverse Limb Events Despite Medical Optimization By Race
Nallely Saldana-Ruiz, MD, MPH, Gregory A. Magee, MD, Kenneth Ziegler, MD, Sukgu M. Han, MD, Fred A. Weaver, MD, Vincent L. Rowe, MD.
University of Southern California, Los Angeles, CA, USA.
OBJECTIVES: Peripheral arterial disease affects 8.5 million people nationally. Critical limb threatening ischemia (CLTI), the end of the PAD spectrum, is associated with limb-related complications and utilization of health care resources. Medical optimization improves clinical outcomes for patients undergoing intervention for CLTI, yet significant racial disparities persist. We evaluated outcomes following endovascular peripheral vascular interventions (PVI) based on race for CLTI patients on pre-operative medical therapy. METHODS: CLTI patients who underwent an PVI in Vascular Quality Initiative national database from (2007-2018). We analyzed differences in age, sex, preoperative risk factors, by race categories. Our main outcomes were major adverse limb events (MALE) and major adverse cardiovascular events (MACE). Univariate and multivariate analyses were conducted. A statistical significance of P=0.05 was used.
RESULTS: A total of 43,102 CLTI patients were identified. After excluding missing data for primary predictors, our cohort consisted of 29,302 statin using CLTI patients. Fifty-nine percent were male, 40.4% female (P<0.0001). Non-White race was 26.7% (n=7815), White race for 73.3%. Mean age was 67.2+/-11.2 for non-White and 69.9+/-11.2 years for White patients (P<0.0001). Rest pain and tissue loss accounted for 32.3% and 67.7%, respectively. Non-White patients were more likely to be Medicaid or self-pay, undergo inpatient, urgent or emergent procedures and have a history of stroke, diabetes, or dialysis. Multivariate logistic regression models, adjusting for significant risk factors, demonstrated that non-White patients have increased odds of MALE (OR 1.26, P=0.04), but no difference in MACE compared to White patients (P=0.54). CONCLUSIONS: Non-White CLTI patients have higher likelihood of MALE, compared to their White race counterparts, despite similar rates of medical optimization by statin and anti-platelet agent utilization. Additional research should focus on individual, modifiable risk factors contributing to differences in outcomes by race in efforts to improve outcomes for all CTLI patients.
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