Abstract P380: The Cardiovascular Fate in Patients with Amputation or Revascularization for Critical Limb Ischemia

Abstract

Background: Critical limb ischemia (CLI) continues to be a significantly morbid disease for the aging population with high likelihood of cardiovascular mortality and morbidity. Objective: To analyze incidence and timing of all cause and cardiovascular mortality (CM) in patients who survived after intervention for CLI. Methods: Patients consecutively discharged with diagnosis of CLI during the period 2006-2008 were re-evaluated for cardiovascular morbidity after 2 years. Patients receiving revascularization either open or endovascular and those with primary major amputation were compared with Kaplan-Meier analyses. The effect of treatment on outcome was analyzed with Cox analysis. Results: There were 257 patients (171 men, aged 74.12y), 39 treated by primary major amputation and 218 by revascularization. During a mean follow-up of 37months, 81 patients died for all cause mortality and 35 for CM. Mean survival time was 57.4months. More than half deaths (n=44) occurred by 15 months with 21 patients dying in the first 6 months and 33 within the first 12 months. Thirty-five myocardial infarctions and 15 strokes occurred. Cumulative survival rate at 60 months was 54% for all cause mortality and 79% for CM. There was significantly worse survival in patients with primary amputation when compared to those receiving revascularization: rates for all cause mortality were 45% vs. 75% (p=0.001) and rates for CM were 68% vs. 90% (p<0.0001), in primary amputation and revascularization group respectively at 42 months. Unadjusted odd ratios for all cause and cardiovascular mortality in patients with primary amputation vs. revascularization were 3.07 (95%CI 1.5-6.1, p=0.002) and 5.25 (95%CI 2.3-11.6, p<0.0001), respectively. After adjusting for age and gender, primary amputation persisted as independent predictor of all cause (HR 2.76, p<0.0001) and cardiovascular mortality (HR 5.11; p<0.0001). Conclusion: Mortality and CM after 2 years in patients surviving from CLI procedures are high. Primary amputation is a strong predictor of poor prognosis in the mid-long term for patients with CLI. Most deaths occur in the first 15 months after treatment. This data may question the benefits of revascularization.