2026 Volume 33 Issue 11 Pages 1355-1365
Aim: Chronic limb-threatening ischemia (CLTI), the most advanced stage of lower-extremity artery disease, is associated with high mortality and major amputation rates, even after revascularization. Thus, identifying patients with CLTI at a particularly high risk of poor outcomes is crucial for shared decision making. Recently, the C-reactive protein-to-albumin ratio (CAR) has emerged as a novel composite biomarker that reflects both the inflammatory and nutritional status. Nonetheless, the prognostic significance of CAR in patients with CLTI undergoing endovascular therapy (EVT) remains unclear.
Methods: Of 159 patients who underwent EVT for the first time between April 2010 and December 2023, 79 were included in this study. The patients were categorized into two groups using a CAR value of 0.17: the high-CAR group (CAR ≥ 0.17) and the low-CAR group (CAR ＜0.17). The primary endpoint was 1-year amputation-free survival (AFS) after EVT.
Results: The median follow-up period was 23 months (95% confidence interval [CI], 11–34). During the follow-up period, 56 patients (71%) died and 11 (14%) underwent major amputation. AFS was significantly reduced in the high-CAR group (log-rank P＜0.01). The CAR (hazard ratio: 1.43 per one-unit increase, 95% CI: 1.20–1.70, P＜0.01) was an independent predictor of reduced AFS following EVT.
Conclusions: elevated preprocedural CAR was independently associated with reduced AFS after EVT in patients with CLTI. The CAR may serve as a valuable tool for evaluating patients with CLTI before EVT.
