Age-Related Outcomes After Revascularization for Chronic Limb-Threatening Ischemia: An Analysis of BEST-CLI

BACKGROUND: The impact of age on outcomes after revascularization for chronic limb-threatening ischemia has not been studied in a prospective trial. METHODS: A total of 1780 patients were grouped into age quartiles (≤55 years, 55< age ≤65 years, 65< age ≤75 years, and >75 years) and by type of revascularization (open bypass or endovascular). The primary outcome was major adverse limb events (MALE) or death, and the secondary outcomes were above-ankle amputation, reintervention, and major adverse cardiovascular events. RESULTS: Death and major adverse cardiovascular events were significantly higher in the oldest quartile (>75 years), whereas MALE and above-ankle amputation were highest in the youngest cohort (≤55 years). Younger patients (≤55 years) had the lowest adjusted risk of MALE or all-cause death with open bypass compared with endovascular revascularization. There was no difference in MALE or all-cause death by treatment strategy in patients >75 years of age. CONCLUSIONS: Older age was associated with the highest risks of death and major adverse cardiovascular events and the lowest risks of MALE and above-ankle amputation among patients enrolled in BEST-CLI (Best Endovascular Versus Best Surgical Therapy in Patients With Chronic Limb-Threatening Ischemia). Age also had a differential impact by revascularization strategy: youngest patients had the lowest risk of MALE and all-cause death with bypass surgery compared with endovascular revascularization, while there was no difference among those >75 years. These data should be used to facilitate shared decision-making in patients with chronic limb-threatening ischemia.