Functional capacity improvement and cardiovascular events after lower extremity revascularization
Sean P. Heffron, Yuhe Xia, Crystalann Rodriguez, Caron B. Rockman, Jeffrey S. Berger
Abstract
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.
Introduction
Functional status is a powerful predictor of clinical outcomes in patients with peripheral artery disease (PAD) [1]. Lower extremity revascularization (LER) is commonly performed in symptomatic PAD to improve blood flow, limb outcomes and quality of life, although patients often remain at increased risk of cardiovascular (CV) events [2].
Materials and methods
Men and women scheduled for LER procedures at NYU Tisch Hospital or Bellevue Hospital Center (New York, NY) provided written informed consent and were enrolled from February 28, 2014 to September 28, 2015 into an IRB-approved protocol (NCT02106429) conforming to the Declaration of Helsinki.
Results
Overall, 143 participants (74 [67, 82] years, 36.4% female, 40.6% non-White) had DASI scores at baseline and 6-months. Pre-LER ABI of the cohort was 0.57 [0.42, 0.97] and did not differ between groups. Sixty-three patients underwent open revascularization, 66 endovascular, and 14 hybrid revascularization.
Discussion
Our findings suggest that functional capacity prior to and at 6-months following LER are strongly associated with clinical outcomes in patients with severe PAD over several years following LER. Patients with lower than average for the cohort functional capacity pre-procedure who failed to improve post-procedure were at significantly higher risk of adverse outcomes than all other patients.
Conclusion
Among patients with severe PAD undergoing LER, improvement in very low functional capacity over the first 6 months after the procedure was associated with long-term risks of MACLE and all-cause mortality equivalent to those individuals with greater than the median functional capacity pre-LER, whereas persistently lower functional status identified a particularly high-risk group.
Citation: Heffron SP, Xia Y, Rodriguez C, Rockman CB, Berger JS (2026) Functional capacity improvement and cardiovascular events after lower extremity revascularization. PLoS One 21(9): e0357038.
https://doi.org/10.1371/journal.pone.0357038
Editor: Athanasios Saratzis, NIHR Leicester Biomedical Research Centre, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
Received: January 29, 2026; Accepted: August 11, 2026; Published: September 1, 2026
Copyright: © 2026 Heffron et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The data presented in this manuscript are derived from human subjects who continue to obtain medical care within our institutions and cannot be shared publicly. Data requests can be directed to: irb-info@nyulangone.org (212) 263-4110 1 Park Avenue, 6th Floor New York, NY 10016.
Funding: JSB was supported by R01HL114978, R35HL144993, R01HL157430 from the United States National Heart, Lung and Blood Institute. The funders did not play any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. https://www.nhlbi.nih.gov/.
Competing interests: The authors have declared that no competing interests exist.
