Cardiovascular Impact of Endovascular Revascularization in Chronic Limb-Threatening Ischemia Versus Claudication: A Contemporary Real-World Analysis

Background Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease, yet long-term cardiovascular outcomes after endovascular revascularization compared with claudication remain poorly defined. Methods Using the TriNetX global research network (114 health care organizations), adults undergoing endovascular lower-extremity revascularization for CLTI or intermittent claudication were identified. Propensity score matching for demographics, comorbidities, and cardiovascular medications yielded 3727 matched pairs. Major adverse cardiovascular events (all-cause mortality, myocardial infarction, or stroke) and secondary outcomes were assessed at 1, 3, and 5 years. Results At 5 years, patients with CLTI experienced a significantly higher risk of major adverse cardiovascular events compared with those with claudication (34.9% vs 30.7%; P < .001), along with greater all-cause mortality (18.7% vs 15.6%; P < .001), heart failure hospitalization (15.0% vs 13.0%; P = .001), major bleeding (15.1% vs 13.3%; P = .002), and acute kidney injury (26.4% vs 22.2%; P < .001). Rates of stroke or transient ischemic attack were similar between groups, whereas repeat revascularization was lower among patients with CLTI (45.9% vs 51.2%; P = .002). These findings were consistent at 1- and 3-year follow-up. Conclusions Chronic limb-threatening ischemia patients undergoing endovascular revascularization experience significantly worse short- and long-term cardiovascular outcomes compared with claudication, underscoring the need for intensified cardiovascular risk stratification and secondary prevention in this high-risk population following peripheral intervention.