While percutaneous coronary intervention (PCI) is a common and often life-saving procedure for treating heart disease, a new analysis of nationwide data reveals a rare but serious potential complication: acute limb ischemia. Published January 30, 2026, in the Journal of the american Heart Association, the study highlights a substantially elevated risk of amputation and death for PCI patients who develop this condition, particularly those with pre-existing peripheral artery disease. Researchers examined data from over 630,000 patients undergoing PCI between 2016 and 2020 to better define the incidence and outcomes of this often-overlooked vascular risk.
From the medical literature
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Rare but Serious: Acute Limb Ischemia Can Occur After Coronary Angioplasty, Carrying a Poor Prognosis, Especially for Those with Peripheral Artery Disease.
While acute bleeding, often resulting from perforation, is a primary concern when considering complications after percutaneous coronary intervention (PCI), rarer events like acute limb ischemia can occur and are associated with significantly worse outcomes. Understanding these less common risks is crucial for comprehensive patient care.
Given the widespread use of catheter-based procedures – approximately 600,000 PCIs are performed annually in the United States alone – a thorough understanding of periprocedural complications is essential, according to a team led by Dr. Monil Majmundar at the University of Kansas Medical Center. Acute limb ischemia, in particular, is linked to high rates of illness and death. However, data on its frequency and outcomes following PCI have been limited, prompting the researchers to analyze data from the Nationwide Readmissions Database, a U.S. registry.
The analysis included approximately 630,000 patients who underwent PCI for stable coronary heart disease between 2016 and 2020. A total of 0.55% (3,456 individuals) experienced acute limb ischemia, with 82.9% affecting the leg and 12.0% affecting the arm. Patients who developed this complication also exhibited a significantly higher burden of other health conditions. Peripheral artery disease (PAD) was present in 90.7% of those with post-intervention acute ischemia, compared to only 23.6% of those without the complication.
Conditions such as heart failure, coagulation disorders, and liver disease were also significantly more common among patients experiencing ischemia. PAD emerged as the strongest predictor, with a 53-fold increased risk (Odds Ratio 53.03). The use of arterial closure devices after PCI is also discussed as a potential risk factor for limb complications, though the registry data did not provide information on this specific aspect.
Acute limb ischemia increased in-hospital mortality by a factor of 1.6, and the risk of major amputation increased 4.7-fold. Treatment involved embolectomy in 40.9% of cases and thrombolysis in 11.6%. Hospital mortality was higher following embolectomy, while thrombolysis was associated with a greater risk of major amputation. The specific limb affected did not significantly influence overall outcomes.
The researchers acknowledge limitations inherent in their study, stemming from the use of registry data. Nevertheless, they believe their investigation fills a significant gap in the existing medical literature.
Majmundar M et al. J Am Heart Assoc 2025; 14: e040026; doi:10.1161/JAHA.124.040026
