Major adverse cardiovascular events and mortality predictors in acute limb ischemia

Background: This study determined the incidence of major adverse cardiovascular events and identified independent predictors of in-hospital mortality in patients with acute limb ischemia undergoing revascularization. Methods: A retrospective cohort study was conducted on 240 consecutive patients with acute limb ischemia who underwent revascularization at a tertiary-care academic hospital between February 2014 and February 2022. Perioperative adverse events were recorded, and multivariable logistic regression was used to identify independent predictors of in-hospital mortality. Results: In-hospital major adverse cardiovascular events occurred in 42 patients (17.5%), while cardiovascular death accounted for 1.7%. All-cause in-hospital mortality was 13.3% (32 patients). On univariable analysis, markers of physiological stress including leukocytosis and elevated neutrophil-to-lymphocyte ratio, renal dysfunction, and multiple postoperative complications were significantly associated with mortality. Multivariable analysis identified four independent predictors: preoperative leukocytosis with white blood cell count greater than 15,000 per microliter (adjusted odds ratio 4.05, 95% confidence interval 1.52–10.75), intraoperative vasopressor use (adjusted odds ratio 4.00, 95% confidence interval 1.48–10.83), postoperative respiratory failure (adjusted odds ratio 8.44, 95% confidence interval 3.20–22.27), and postoperative bowel ischemia (adjusted odds ratio 15.24, 95% confidence interval 2.40–96.90). Conclusions: Major adverse cardiovascular events are frequent but not independently associated with in-hospital mortality in patients with acute limb ischemia undergoing revascularization. Mortality is determined by a cascade of perioperative systemic insults rather than isolated cardiovascular events. Postoperative surveillance should prioritize early recognition of respiratory failure and bowel ischemia, particularly in patients presenting with leukocytosis or requiring intraoperative vasopressor support.