Among patients with severe PAD undergoing lower extremity revascularization, failure to improve functional capacity at 6 months post-LER was associated with higher rates of long-term MACLE and mortality, whereas patients making even modest gains in functional capacity post-LER experienced outcomes comparable to those with consistently greater than cohort average function.
Key Findings
Results
Persistently low functional capacity after lower extremity revascularization was associated with significantly higher risk of all-cause mortality compared to persistently higher functional capacity.
Patients in the Lower-to-Lower group had a hazard ratio of 6.78 (p = 0.01) for death relative to the Higher-to-Higher group in Cox models adjusted for demographic and clinical covariates.
Mortality rates differed significantly across the three functional capacity groups (p < 0.05) in landmark analyses from 6 months onward.
The cohort had a median age of 74 years, was 36.4% female, and 40.6% non-White.
Results
Persistently low functional capacity was associated with a numerically higher but statistically marginal risk of major adverse cardiovascular and limb events (MACLE) compared to persistently higher functional capacity.
The Lower-to-Lower group had an adjusted HR of 2.03 (p = 0.09) for MACLE relative to the Higher-to-Higher group.
MACLE was defined as a composite of death, myocardial infarction, stroke, major amputation, or acute limb ischemia requiring revascularization.
MACLE rates differed significantly across the three functional capacity groups overall (p < 0.01).
Results
Patients whose functional capacity improved from below to above the cohort median at 6 months post-LER had long-term outcomes similar to those who maintained consistently higher functional capacity.
The Lower-to-Higher group (n = 28) increased their Duke Activity Status Index (DASI) by 17.0 [11.8, 27.0] points, equivalent to approximately 2.1 METs.
The Lower-to-Higher group's risk of MACLE and mortality was comparable to the Higher-to-Higher group, not the Lower-to-Lower group.
The cohort pre-LER median DASI threshold used to classify groups was 15.95.
Methods
The study cohort of 143 patients with severe PAD undergoing LER had similar baseline ankle-brachial index values across functional capacity groups.
143 participants had DASI data from both before and 6 months after LER.
Baseline ankle-brachial index was 0.56 [0.41, 0.82] and did not differ between groups, indicating similar severity of arterial disease at baseline.
The study was an IRB-approved prospective cohort registered at ClinicalTrials.gov (NCT02106429).
Methods
Functional capacity was measured using the Duke Activity Status Index (DASI) before and at 6 months post-LER, and participants were categorized into three groups based on whether DASI was above or below the cohort pre-LER median at each time point.
The three groups were: Lower-to-Lower (below median at both time points), Higher-to-Higher (above median at both time points), and Lower-to-Higher (below at baseline, above at 6 months).
The cohort pre-LER median DASI was 15.95.
Landmark analyses examined MACLE and all-cause mortality from 6 months onward to avoid immortal time bias.
Cox proportional hazards models were adjusted for demographic and clinical covariates.
What This Means
This research followed 143 patients with severe peripheral artery disease (PAD) — a condition where narrowed arteries reduce blood flow to the legs — who underwent a procedure to restore blood flow (revascularization). Researchers measured how physically capable patients were before and six months after the procedure using a standardized questionnaire called the Duke Activity Status Index (DASI), which estimates how much physical activity a person can perform. Patients were grouped based on whether their physical function stayed low, stayed high, or improved from low to high after the procedure.
The study found that patients who remained in low functional capacity after revascularization had dramatically worse long-term outcomes: they were nearly seven times more likely to die compared to patients who maintained higher functional capacity. Critically, patients who started with low physical function but improved by six months — even by a modest amount (roughly 2 METs, comparable to the effort of light household tasks) — had outcomes that looked similar to those who had good physical function all along, not to those who stayed in poor functional capacity.
This research suggests that functional recovery after lower-limb revascularization may be an important marker of long-term health, and that even modest improvements in physical capacity following the procedure could signal better prognosis. The findings highlight the potential importance of monitoring and supporting functional recovery — not just the technical success of the revascularization itself — as a meaningful goal in caring for patients with severe PAD.