ABSTRACT
Background The impact of COVID-19 on major adverse lower extremity (MALE) and cardiovascular events (MACE) in patients with peripheral artery disease (PAD) is unknown. Methods Using the VA Corporate Data Warehouse, Veterans with PAD were identified. Rates of MALE (amputation or lower extremity revascularization [LER]), and MACE (death, MI, or coronary revascularization) were assessed in pre-pandemic (3/11/2019-3/10/2020), early-pandemic (3/11/2020-3/10/2021), and late-pandemic (3/11/2021-3/10/2022) periods. Outcomes were compared using Kaplan-Meier method. Results Of 418,042 Veterans (mean age 72 yrs) with PAD, 76.7% were white and 96.8% male. Furthermore, 89.2% had HTN, 60.4% diabetes, 49.3% CAD, 21.6% heart failure, and 20.5% atrial fibrillation. From 3/11/2019 to 3/10/2022, 3,100 had amputation, 8,187 had LER, & 2,229 had MACE. Amputation rates declined and continued to decline in early- and late-pandemic period (306 to 268 to 235;p<0.001;rates per 100k). Rates of LER declined initially and stabilized in late-pandemic period (951 to 587 to 609;p < 0.001;rates per 100k). MACE did not change significantly. (215 to 168 to 202;p<0.001;rates per 100k). Conclusion Amputation rates in Veterans with PAD did not increase despite a clinically significant decline in LER. Given the known efficacy of noninvasive therapies in PAD, these data suggest that there is a need to re-evaluate appropriate indications for LER and amputation. [Formula presented]Copyright © 2023 American College of Cardiology Foundation