Perioperative cardiac optimization in patients with lower limb critical ischemia and ischemic heart disease

Aim: Patients with chronic limb-threatening ischemia (CLTI) and concomitant ischemic heart disease (IHD) are at high risk of perioperative cardiovascular complications following vascular interventions. The impact of preoperative coronary revascularization on short-term postoperative outcomes remains controversial. To evaluate the association between preoperative coronary revascularization and perioperative major cardiac events (MCEs), myocardial infarction (MI), and mortality in patients with CLTI and concomitant IHD undergoing vascular surgery.

Material and Methods: This retrospective study included 963 patients with CLTI treated between 2017 and 2023. Among them, 312 patients had concomitant IHD. Preoperative coronary revascularization was performed in 101 patients (main group), while 211 patients received medical management without coronary revascularization (control group). The primary outcome was the occurrence of MCEs within 30 days after surgery, including myocardial infarction, acute heart failure, unstable angina, major arrhythmias, and all-cause mortality.

Results: MCEs occurred in 6 patients (5.9%) in the coronary revascularization group compared with 39 patients (18.5%) in the control group (p < 0.01). Myocardial infarction occurred in 3 (3.0%) versus 15 (7.1%) patients, while mortality was observed in 3 (3.0%) and 11 (5.2%) patients, respectively. All patients received guideline-directed medical therapy for cardiovascular risk reduction during the perioperative period.

Conclusion: In this retrospective cohort, preoperative coronary revascularization was associated with a lower incidence of perioperative MCEs, myocardial infarction, and 30-day mortality in patients with concomitant CLTI and IHD. Prospective, multicenter studies are warranted to confirm these findings.