VESS12 - Presenting Severity of Limb Threat Does Not Account for Racial & Ethnic Disparities in Major Adverse Limb Events After Peripheral Vascular Intervention for Chronic Limb Threatening Ischemia

Objectives: Racial and ethnic disparities have been well documented in chronic limb threatening ischemia (CLTI) outcomes and one purported explanation is disease severity at presentation. We hypothesize that disparities in major adverse limb events (MALE) following peripheral vascular intervention (PVI) for CLTI would persist despite controlling for presenting disease severity using Wound, Ischemia, and foot Infection (WIfI) staging.

Methods: The VQI PVI dataset (2016-2021) was queried for CLTI and exclusion criteria was missing WIfI stage and 1-year follow-up. The primary end point was 1-year MALE (major amputation or re-intervention). A multivariable hierarchical Fine Gray Analysis was performed controlling for hospital variation, competing risk of death, and presenting WIfI stage to assess the independent association of Black/African American race and Latinx/Hispanic ethnicity with MALE.

Results: Overall, 24,283 cases (30.3%) had both WIfI stage and 1-year follow-up with 18,131 (74.7%) White, 4,832 (19.9%) Black, and 1,320 (5.4%) Latinx patients. The 1-year cumulative incidence of MALE was 14.9% (95% CI 14.5-15.3) for White, 16.5% (95% CI 15.7-17.4) for Black, and 20.9% (95% CI 19.2-22.6) for Latinx patients (Fig 1). On bivariate analysis, MALE was significantly associated with younger age, Black race, Latinx ethnicity, CAD, CVD, CHF, hypertension, diabetes, dialysis, intervention level, any prior minor or major amputation, and WIfI stage (p < 0.001). Cumulative incidence of 1-year MALE increased by WIfI stage: stage 1 – 12.6% (95% CI 12.0-13.3), stage 2 – 14.2% (95% CI 13.6-14.7), stage 3 – 17.8% (95% CI 16.9-18.7), stage 4 – 19.4% (95% CI 18.3-20.4), and by intervention level: inflow – 12.2% (95% CI 11.2-12.9), femoropopliteal – 13.9% (95% CI 13.4-14.4), infrapopliteal – 17.1% (95% CI 16.5-17.7) (p < 0.001). After adjusting for death and WIfI stage, Black race (SHR 1.23; 95% CI 1.16-1.32, p< 0.001) and Latinx ethnicity (SHR 1.65; 95% CI 1.50-1.82, p< 0.001) was associated with an increased 1-year hazard of MALE compared to White race. On multivariable Fine Gray analysis, MALE disparities persisted for Black race (SHR 1.09; 95% CI 1.02-1.16, p=0.01) and Latinx ethnicity (SHR 1.42; 95% CI 1.29-1.57, p< 0.001) compared to White race (Fig 2).

Conclusions: Black and Latinx patients have a higher associated MALE rate after PVI for CLTI compared to White patients despite WIfI stage at presentation. This data suggests that ongoing efforts are necessary to understand underlying mechanisms for disparities in historically marginalized racial and ethnic groups presenting with CLTI.