The Geriatric Nutritional Risk Index (GNRI) was developed to assess the nutritional risk and is associated with mortality. However, there are limited reports on the relationship between the GNRI and overall survival (OS) in peripheral artery disease (PAD). Therefore, the purpose of this study was to examine the relationship between GNRI and OS and cardiovascular or limb events in patients with PAD. Methods: A prospective cohort study was performed on 1,219 patients with PAD. The baseline GNRI was calculated from the serum albumin level and body mass index obtained at the first visit. The patients were divided into four groups according to the GNRI: G0 (98), G1 (92-98), G2 (82-91), and G3 (82). The endpoints were OS and freedom from major adverse cardiovascular events (MACE) and MACE plus limb events (MACLE). Results: The median follow-up period was 73 months. There were 626 deaths (51.4%) during the follow-up. The rate of cardiovascular death was 51.3%. OS clearly depended on the GNRI (p 0.01), with five-year OS rates of 80.8% for G0, 62.0% for G1, 40.0% for G2, and 23.3% for G3. In multivariate analyses, the GNRI, age, ankle-brachial pressure index (ABPI), critical limb ischemia, estimated glomerular filtration rate (eGFR), and C-reactive protein (CRP) were independent factors associated with OS, and GNRI, age, ABPI, coronary artery disease, diabetes mellitus, eGFR, and CRP were associated with MACE and MACLE (all p 0.05). Statins were found to improve OS, MACE, and MACLE (p 0.01). Conclusions: GNRI is an independent predictor for OS, MACE, and MACLE in patients with PAD. Malnutrition is common and is associated with increased mortality in cardiovascular disease (CVD), such as CAD and stroke 5, 6) , and nutritional indicators such as BMI, serum albumin, and total cholesterol are predictors of survival in patients with CVD 5-7). The geriatric nutritional risk index (GNRI) is calculated from serum albumin and components of BMI and was developed as a screening tool to assess nutritional risk 8). This index is a simple and established nutritional assessment in subjects who have CVD and those on hemodialysis, as well as other elderly patients 8-11). However, long-term life expectancy, including cardiovascular events and the fate of the leg, according to the GNRI in diverse patients with PAD,