LAUSR

AIM To describe the practice patterns of evidence-based medical therapy (EBM) and overall mortality in high-risk patients with critical limb-threatening ischemia (CLTI), compared to patients with myocardial infarction (MI). METHODS Using Danish registries, we identified patients 40-100 years of age with a first-time hospitalization for CLTI or MI from 2008-2018 and grouped them into; CLTI, MI, and CLTI and history of MI (CLTI + MI). We examined the likelihood of filling prescriptions with EBM (i.e. antiplatelets [AP], lipid-lowering agents [LLA], angiotensin-converting enzyme inhibitor [ACEi], or angiotensin II-receptor blockers [ARB]) within 3 months after discharge among survivors. Further, we assessed the adjusted three-year mortality rates. RESULTS We included 92,845 patients: 14,941 with CLTI (54.7% male), 74,830 with MI (64.6% male) and 3,074 with CLTI + MI (65.2% male). Patients with CLTI and CLTI + MI were older and had more comorbidities than patients with MI. Compared to patients with MI, the unadjusted odds ratios of filling prescriptions were 0.15 (CI 0.14-0.15) for AP, 0.26 (CI 0.25-0.27) for LLA, and 0.71 (CI 0.69-0.74) for ARB/ACEi in patients with CLTI, and 0.22 (CI 0.20-0.24) for AP, 0.38 (CI 0.35-0.42) for LLA, and 1.17 (CI 1.08-1.27) for ARB/ACEi in patients with CLTI + MI. Adjusted analyses showed similar results. Compared to patients with MI, adjusted three-year hazard ratios for mortality were 1.69 (CI 1.64-1.74) in patients with CLTI and 1.60 (CI 1.51-1.69) in patients with CLTI + MI. CONCLUSION Patients with CLTI were undertreated with EBM and carried a more adverse prognosis, as compared to patients with MI, despite similar guidelines.