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Peer-reviewedCC BY 4.0PLOS One

Functional capacity improvement and cardiovascular events after lower extremity revascularization

  • Sean P. Heffron1
  • Yuhe Xia2
  • Crystalann Rodriguez3
  • Caron B. Rockman4
  • Jeffrey S. Berger5
5 affiliations
  1. 1Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York, United States of America
  2. 2NYU Center for the Prevention of Cardiovascular Disease, NYU Grossman School of Medicine, New York, New York, United States of America
  3. 3Division of Biostatistics, NYU Grossman School of Medicine, New York, New York, United States of America
  4. 4Department of Vascular Surgery, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
  5. 5Department of Surgery, NYU Grossman School of Medicine, New York, New York, United States of America
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Abstract

Background: Functional status predicts outcomes in peripheral artery disease (PAD), but the relevance of changes in functional capacity after lower extremity revascularization (LER) and long-term events is unclear. Methods: In an IRB-approved prospective cohort, we evaluated adjudicated major adverse cardiovascular and limb events (MACLE: death, myocardial infarction, stroke, major amputation, or acute limb ischemia requiring revascularization) among patients with severe PAD undergoing LER. Functional capacity was assessed using the Duke Activity Status Index (DASI) prior to and at 6 months post-LER. Participants were categorized as: Lower-to-Lower (DASI below cohort pre-LER median [15.95] at both time points), Higher-to-Higher (above median at both), or Lower-to-Higher (below at baseline, above at 6 months). Landmark analyses examined MACLE and all-cause mortality from 6 months onward, with Cox models adjusted for demographic and clinical covariates. Results: Overall, 143 participants had DASI data from before and 6 months after LER (median age 74 years; 36.4% female; 40.6% non-White). Baseline ankle-brachial index (0.56 [0.41, 0.82]) did not differ between groups. The Lower-to-Higher group (n = 28) increased DASI by 17.0 [11.8, 27.0] points (~2.1 METs). MACLE (p < 0.01) and mortality (p < 0.05) differed significantly across groups. Persistently lower DASI was associated with higher adjusted risks of MACLE (HR = 2.03, p = 0.09) and death (HR = 6.78, p = 0.01) relative to persistently higher DASI. Patients whose DASI improved (Lower-to-Higher) had risk similar to those who sustained DASI above the cohort pre-LER median (Higher-to-Higher group). Conclusions: Among patients with severe PAD undergoing LER with very low DASI, 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.

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Cite

BibTeXRIS
BibTeX
@article{heffron2026functional,
  title = {{Functional capacity improvement and cardiovascular events after lower extremity revascularization}},
  author = {Sean P. Heffron and Yuhe Xia and Crystalann Rodriguez and Caron B. Rockman and Jeffrey S. Berger},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0357038},
  url = {https://doi.org/10.1371/journal.pone.0357038},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Functional capacity improvement and cardiovascular events after lower extremity revascularization
AU  - Sean P. Heffron
AU  - Yuhe Xia
AU  - Crystalann Rodriguez
AU  - Caron B. Rockman
AU  - Jeffrey S. Berger
PY  - 2026
DA  - 2026/09/01
JO  - PLOS One
DO  - 10.1371/journal.pone.0357038
UR  - https://doi.org/10.1371/journal.pone.0357038
AB  - Background: Functional status predicts outcomes in peripheral artery disease (PAD), but the relevance of changes in functional capacity after lower extremity revascularization (LER) and long-term events is unclear. Methods: In an IRB-approved prospective cohort, we evaluated adjudicated major adverse cardiovascular and limb events (MACLE: death, myocardial infarction, stroke, major amputation, or acute limb ischemia requiring revascularization) among patients with severe PAD undergoing LER. Functional capacity was assessed using the Duke Activity Status Index (DASI) prior to and at 6 months post-LER. Participants were categorized as: Lower-to-Lower (DASI below cohort pre-LER median [15.95] at both time points), Higher-to-Higher (above median at both), or Lower-to-Higher (below at baseline, above at 6 months). Landmark analyses examined MACLE and all-cause mortality from 6 months onward, with Cox models adjusted for demographic and clinical covariates. Results: Overall, 143 participants had DASI data from before and 6 months after LER (median age 74 years; 36.4% female; 40.6% non-White). Baseline ankle-brachial index (0.56 [0.41, 0.82]) did not differ between groups. The Lower-to-Higher group (n = 28) increased DASI by 17.0 [11.8, 27.0] points (~2.1 METs). MACLE (p < 0.01) and mortality (p < 0.05) differed significantly across groups. Persistently lower DASI was associated with higher adjusted risks of MACLE (HR = 2.03, p = 0.09) and death (HR = 6.78, p = 0.01) relative to persistently higher DASI. Patients whose DASI improved (Lower-to-Higher) had risk similar to those who sustained DASI above the cohort pre-LER median (Higher-to-Higher group). Conclusions: Among patients with severe PAD undergoing LER with very low DASI, 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.
SN  - 1932-6203
ER  -