Ricciardi, Mark

Background: It is uncertain whether presence of CAD has a prognostic implication in patients (pts) with CLI. We sought to compare the trends and outcomes of pts with CLI based on presence of history of CAD. Methods: Temporal trends in hospitalization for CLI based on history of CAD were determined using the 2000-2018 NIS database. A multivariable regression analyses of outcomes was performed based on the CAD status and revascularization type. Propensity score matching was used to compare outcomes based on type of revascularization. Primary outcome of interest was in-hospital mortality. Results: Among 13,570,000 pts with CLI (41% female, 69% whites, mean age 69 years), 23% had concomitant CAD and 9.6% underwent revascularization (42.6% endovascular & 57.4% surgical). In pts with CLI, there was an increasing trend in the prevalence of CAD (Figure; Panel A). Furthermore, in pts with CLI + CAD, the frequency of endovascular revascularization increased from 15% to 48% while there was a decreasing trend of surgical revascularization (85% to 52%). After multivariate adjustments, CLI + CAD was associated with increased risk of in-hospital mortality (OR: 1.40; CI: 1.32-1.47) & bleeding requiring transfusion (OR: 1.10; CI: 1.06-1.12) than those with CLI without CAD (Figure; Panel B). Among both patients with CLI + CAD & CLI without CAD, endovascular revascularization was associated with lower likelihood of in-hospital mortality (OR: 0.69; CI: 0.63- 0.76 & OR: 0.71; CI: 0.67-0.76) & bleeding requiring transfusion (OR: 0.40; CI: 0.38- 0.43 & OR: 0.44; CI: 0.43- 0.46) than surgical revascularization. Conclusions: Increasing prevalence and poor prognosis of CAD among patients with CLI warrants immediate attention to optimize preventive and treatment strategies.