Acute Limb Ischemia After Percutaneous Coronary Intervention for Stable Coronary Artery Disease.

INTRODUCTION: Despite its severity, there is limited information on the incidence, predictors, and outcomes of acute limb ischemia (ALI) after percutaneous coronary interventions (PCIs) in stable coronary artery disease.

METHODS AND RESULTS: We included all patients undergoing PCI for stable coronary artery disease in the Nationwide Readmissions Database from 2016 to 2020, identifying them using appropriate International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), codes. Our primary outcomes were the incidence and predictors of ALI. A total of 629 656 patients underwent PCI for stable coronary artery disease. Of this sample, 3456 (0.55%) had ALI. Peripheral artery disease was the strongest predictor of post-PCI ALI (odds ratio, 53.03 [95% CI, 43.76-64.28], P<0.001). Patients with ALI had a 1.6 times greater risk of in-hospital mortality and a 4.7 times greater risk of in-hospital major amputation. Forty point nine percent of patients with ALI underwent embolectomy, while 11.6% received thrombolysis. Outcomes were similar between ALI of the upper and lower extremity. Patients undergoing embolectomy had greater in-hospital mortality, while the thrombolysis group had greater in-hospital major amputation.

CONCLUSION: ALI is an uncommon complication of PCI but is associated with a high risk of mortality and amputation. Peripheral artery disease is the strongest predictor of post-PCI ALI.