Coronary bypass outcomes in chronic limb-threatening ischemia are significantly worse than in patients with non-critical lower extremity arterial disease

Abstract Purpose Lower extremity arterial disease (LEAD) is a risk factor in patients undergoing coronary artery bypass grafting (CABG); however, the impact of chronic limb-threatening ischemia (CLTI), its most advanced stage, remains unclear. We evaluated early and long-term outcomes of CABG in CLTI. Method We retrospectively analyzed 334 consecutive patients who underwent isolated CABG between 2014 and 2024. Patients were stratified into three groups: CLTI (n = 22), non-CLTI LEAD (n = 41), and non-LEAD (n = 271). The primary endpoint was long-term survival; the secondary endpoints were 30-day mortality and major adverse cardiac and cerebrovascular events. Results The CLTI group had higher rates of diabetes mellitus (90.9%) and hemodialysis (86.4%) (p < 0.01). Thirty-day mortality was similar (9.1%, 2.4%, and 5.5%; p = 0.52), whereas five-year survival was significantly lower in the CLTI group (39.8% vs. 86.2% and 90.8%; p < 0.01). A Cox analysis showed that age, hemodialysis, and acute myocardial infarction were independent predictors of 5-year survival. Conclusions CLTI predicts poor long-term survival because of comorbidities. In this high-risk population, individualized strategies balancing the extent of coronary revascularization against operative risk may achieve acceptable early outcomes, although the safety of incomplete/functional revascularization requires confirmation in larger cohorts.