Influence of heart failure on the clinical outcomes of patients with chronic limb-threatening ischemia after infrainguinal revascularization

OBJECTIVE: We examined the influence of heart failure (HF) on patients with chronic limb-threatening ischemia (CLTI) and the negative predictors of limb and life prognosis among patients with CLTI and HF, the clinical outcomes of patients with CLTI after infrainguinal revascularization were compared. METHODS: Multicenter data of patients who underwent infrainguinal revascularization for CLTI between 2015 and 2022 were analyzed retrospectively. The end point was amputation-free survival (AFS) among patients with HF or without HF. Subgroup analyses among patients with HF were performed grouped by revascularization procedures or ejection fraction (EF) classification: HF with reduced EF (HFrEF) (EF of <40%), HF with mildly reduced EF (HFmrEF) (40% ≤ EF < 50%), and HF with preserved EF (HFpEF) (EF ≥50%). RESULTS: Of the 772 patients included, 186 (24%) had HF. No differences were found in the Wound, Ischemia, foot Infection (WIfI) stage, Global Limb Anatomic Staging System stage, or treatment procedures between the HF and non-HF groups. The 2-year AFS rates of the HF and non-HF groups were 63% ± 2% vs 50% ± 4%, respectively (P < .01). Among the HF group, the AFS of the bypass group was significantly higher than that of the endovascular therapy (EVT) group (59% ± 7% vs 46% ± 5%; P = .04). Then, the AFS rates of the HFpEF, HFmrEF, and HFrEF groups were 61% ± 6%, 50% ± 8%, and 35% ± 7%, respectively (P < .01). Multivariate Cox proportional hazard analyses identified age ≥80 years, nonambulatory status, hypoalbuminemia (<3.5 g/dL), end-stage renal disease, EVT, WIfI stage 4, and HF as negative predictors of AFS among all patients. In the HF group, age ≥80 years, nonambulatory status, EVT, WIfI stage 4, and reduced EF (<40%) were significant negative predictors. CONCLUSIONS: HF is a robust negative predictor of AFS among patients with CLTI who underwent infrainguinal revascularization. HFrEF was a negative predictor of AFS.