Background: Inflammation and immune dysregulation have been associated with adverse outcomes in cardiovascular disease. There is limited understanding of the association of different profiles of white blood cell (WBC) subsets and red cell distribution width (RDW) in patients with chronic limb-threatening ischemia (CLTI). Methods: Patients with CLTI undergoing endovascular revascularization in our single-center, tertiary care hospital from 2017 to 2019, who had a preceding complete blood count (CBC) with WBC differentials ( n =213), were included in the analysis. Patient characteristics, laboratory values, and clinical outcomes were collected. Cox proportional hazards regression models were used to assess for associations between all-cause mortality and leukocyte subset; multivariate analysis was used to account for confounders. Kaplan–Meier curves were generated to depict survival censored at 1 year postrevascularization using baseline CBC indices. Results: Adjusting for confounders, elevated RDW was associated with increased mortality (continuous per % increase, adjusted hazard ratio [HR] 1.33, p < 0.001). Baseline lymphopenia was associated with mortality in univariate analysis. Other leukocyte subtypes were not associated with mortality outcomes in our population. Exploratory analysis showed negative deflections in ∆WBC from pre- to postprocedure day 1 were affiliated with increased mortality when adjusted for age, sex, race, chronic kidney disease, and baseline hemoglobin (∆WBC HR 1.16, p = 0.004). Further exploratory analysis showed an association between RDW and all-comers readmission. Conclusions: The utilization of a periprocedural WBC subset differential can be a useful adjunct to risk-stratify patients with CLTI undergoing endovascular revascularization. Further studies are needed to understand potential ways to modulate immune dysregulation so as to improve mortality outcomes.

Objectives To assess geriatric nutritional risk index (GNRI) in patients with chronic limb-threatening ischemia (CLTI). Background The prevalence of CLTI continues to rise, with major amputation and mortality remaining prominent. Frailty is a vital risk factor for adverse outcomes in cardiovascular care. The GNRI is a nutrition-based surrogate for frailty that has been utilized in Southeast Asia to predict adverse events in CLTI. It has not yet been evaluated in a primarily Western population, nor in the context of wound healing. Methods Between 8August 2017 and April 2019, we identified patients undergoing endovascular interventions for CLTI at our institution, categorized into low GNRI (<= 94, frail) versus normal GNRI (> 94, reference). We analyzed the risks of major adverse limb events (MALE), its individual components [mortality, major amputation, and target vessel revascularization (TVR)], amputation free survival (AFS), and wound healing using Kaplan-Meier and multivariate cox-proportional hazard regression analyses. Results A total of 255 patients were included in the analysis, with follow up of 14 +/- 9.1 months. Lower GNRI was associated with higher cumulative event rates for MALE (71.0% vs. 43.3%, p < 0.001), mortality (34.3% vs. 15.2%, p < 0.001), major amputation (31.2% vs. 15.8%, p = 0.002), and freedom from AFS (56.0% vs. 28.2%, p < 0.001). There was a trend toward lower TVR and higher wound healing with higher GNRI score. Conclusions Our single-center, retrospective evaluation of GNRI (as a surrogate for frailty) correlated with increased risks of MALE, mortality, and major amputation. Future directions should focus not only on the recognition of these patients, but risk-factor modification to optimize long-term outcomes.

Background: Much is known about mortality trends in coronary artery disease (CAD) and cerebrovascular disease (CVD), yet data reporting mortality trends for peripheral artery disease (PAD) are scarce. We sought to explore overall PAD mortality trends in the US. Methods: The Multiple Cause of Death database from the Center for Disease Control was used to identify patients, aged 25 years and older, who died of PAD between years 2000 to 2019. Patients who died from PAD were identified using International Classification of Diseases 10th revision codes. Patient socioeconomic, demographic, and geographic factors were reported and analyzed. Age-adjusted rate were calculated using a standard population and reported in per-million persons (PMP). Finally, PAD mortality trends were compared to CAD and CVD. Results: A total of 854,616 PAD deaths were identified and showed decreasing mortality from 403 to 99 age-adjusted years PMP from 2000-2019. PAD mortality increased with increasing age (crude rate of 1.0 PMP vs 3806 PMP among 25-34 vs >85 year-olds respectively). PAD mortality was also higher among Black individuals from 2000 to 2006, but has equalized to the mortality rate of White individuals. PAD mortality was higher among men compared to women, but the gap has decreased over time. There was significant geographic state-level variation (3 fold) in PAD mortality, with large fringe metros demonstrating the lowest mortality. When compared to CAD and CVD, PAD mortality decreased by 75% from 2000 and 2019, compared with a 61% reduction in CAD mortality and a 46% reduction in CVD mortality (Figure 1). Conclusion: From 2000 to 2019, mortality due to PAD in the US has decreased at a much higher rate compared to CAD and CVD. Despite this trend, PAD remains a major cause of mortality in the US, disproportionately affecting elderly individuals, generally those living in less metropolitan areas, and men of both White and Black ethnicity, although differences in race and gender are diminishing.

Introduction: The nutrition status plays a key role in the pathogenesis of frailty, and is strongly associated with the prognosis of patients with chronic limb-threatening ischemia (CLTI). The Geriatric Nutritional Risk Index (GNRI) is a widely used, simple, and well established nutritional status screening method. The association between the GNRI and wound healing in patients with CLTI has not been established. Hypothesis: We assessed the hypothesis that GNRI is associated with wound healing in patients with CLTI. Methods: We conducted a single-center retrospective analysis for 172 consecutive CLTI patients who were admitted to our hospital from August 2017 to April 2019 (age 70±14 years; men 62.2%). The GNRI on admission was calculated as follows: [14.89 х albumin (g/dL)] + [41.7 х (bodyweight/ideal body weight)]. According to the GNRI values, 4 grades of nutrition-related risk are defined as major risk (GNRI:<82), moderate risk (GNRI: 82 to <92), low risk (GNRI: 92 to 98), and no risk (GNRI: >98). The amputation-free survival (AFS) and the cumulative wound healing rate are calculated by the log-rank test. The receiver operating characteristic curve was used to obtain a cutoff value for wound heal. Cox proportional hazards regression analysis was performed to explore the independent association between the GNRI and wound heal. Results: The follow-up period was 12±6.7 months. The 1-year AFS in no risk, low risk, moderate risk, and major risk groups were 90%, 74%, 66%, and 62%, respectively ( P =0.045). GNRI was significantly associated with WIfI wound score (W1, 95±8.8; W2, 87±8.0; W3, 84±9.3, P <0.001). The 1-year cumulative wound healing rate in no risk, low risk, moderate risk, and major risk groups were 56%, 45%, 37%, and 32%, respectively ( P =0.036). GNRI=95 was selected as cutoff value with maximum discriminative power for wound healing (sensitivity 70%, specificity 60%; Area under the curve, 0.67; 95% confidence interval, 0.59-0.76). GNRI>95 was an independent predictor of wound healing (Hazard ratio, 1.9; 95% confidence interval, 1.0-3.7; P =0.046). Conclusions: The GNRI was significantly associated with AFS and wound healing in patients with CLTI. GNRI=95 is a novel cutoff value to predict wound healing during follow-up.