Association of pre-procedural activities of daily living status with all-cause mortality after femoropopliteal endovascular therapy.

Pre-procedural functional status may influence prognosis after peripheral endovascular intervention, yet the independent prognostic value of activities of daily living (ADL) status for outcomes after femoropopliteal endovascular therapy (FP-EVT) remains unclear. We retrospectively analyzed 418 consecutive patients undergoing their first FP-EVT at a single center. Pre-procedural ADL was classified as independent (n = 207), ambulatory with assistance (n = 87), wheelchair-bound (n = 95), or bedridden (n = 29). The primary endpoint was all-cause mortality; cause-specific mortality (Fine-Gray models) was secondary, and major adverse cardiovascular events (MACE) and major adverse limb events (MALE) were exploratory. During a median follow-up of 18.1 months, 125 deaths (29.9%) occurred, increasing stepwise across ADL groups (12.6%, 37.9%, 49.5%, 65.5%; 3-year mortality-free survival 85.2%, 62.2%, 50.3%, 24.6%; log-rank P < 0.001). Each one-step ADL decline was independently associated with mortality (hazard ratio [HR] 1.49; 95% confidence interval [CI] 1.17-1.89; P = 0.001). In cause-specific analyses, ADL was most strongly associated with infection-related death (subdistribution HR 1.97; 95% CI 1.50-2.59; P < 0.001). The mortality association was consistent across claudication (HR 1.47; 95% CI 0.98-2.20) and chronic limb-threatening ischemia (CLTI; HR 1.48; 95% CI 1.15-1.92), with no significant interaction (P = 0.699). ADL was not independently associated with MACE or MALE. Non-cardiovascular causes accounted for 76.8% of deaths, with infection the leading cause (39.2%). Pre-procedural ADL status was independently associated with all-cause mortality after FP-EVT, most strongly with infection-related death, and consistently across clinical presentations. Routine ADL assessment may enhance pre-procedural risk stratification.