Abstract 4371211: Impact of Aspirin Use on Amputation Outcomes and Cardiovascular Risk in Peripheral Artery Disease Patients: Insights from a High-Risk Cohort

Background: Aspirin therapy is well-established for secondary prevention of cardiovascular events; however, its role in modifying amputation outcomes in patients with peripheral artery disease (PAD) remains unclear. Research Question: Does aspirin therapy influence the likelihood of major versus minor amputations in PAD? Aims: To evaluate the association between aspirin use and the level of lower extremity amputation (major vs. minor) in patients with PAD. Methods: We conducted a retrospective review of 387 PAD patients undergoing lower extremity amputation, classified as major (n=122) or minor (n=262) procedures. The cohort had a mean age of 64.1 ± 12.8 years and was predominantly male (72.1%). Cardiometabolic comorbidities were highly prevalent, with diabetes in 95.1%, hypertension in 88.4%, and hyperlipidemia in 81.1%. Among these patients, 239 (61.8%) were receiving aspirin therapy. We assessed the prevalence of cardiovascular risk factors, amputation level, reintervention needs, wound healing, and post-operative outcomes. Results: Aspirin users exhibited a substantial burden of comorbid conditions, with diabetes present in 96.2%, hypertension in 92.9%, and hyperlipidemia in 88.3%. Major amputations occurred in 16.3% of aspirin users, while 15.5% underwent minor amputations. Logistic regression demonstrated no significant association between aspirin use and lower odds of major amputation compared to minor amputation (OR 1.07; 95% CI: 0.62–1.85; p=0.806). Secondary amputations occurred in 32.6% of the total cohort, with 30.7% requiring reinterventions. Cardiovascular events post-amputation were notable, with 19.1% experiencing myocardial infarction and 1.0% suffering a stroke. Wound healing was achieved in 78.8%, though recurrent ulceration occurred in 19.4%. Mortality during follow-up was 15.2%. Among aspirin users with available data, disease control was suboptimal: only 56.5% had well-controlled diabetes (HbA1c ≤ 7.5%), 38.1% had LDL cholesterol <2.0 mmol/L, and 59.8% had blood pressure <140/90 mmHg. Notably, none met the prealbumin threshold for adequate nutritional status. Conclusion: In this high-risk PAD population, aspirin use did not confer a statistically significant reduction in the odds of major versus minor amputation. The high prevalence of cardiometabolic risk factors, suboptimal risk factor control, and significant rates of secondary procedures highlights the need for enhanced vascular care.