Prediction Models for Two Year Overall Survival and Amputation Free Survival After Revascularisation for Chronic Limb Threatening Ischaemia


      The aim of this study was to create prediction models for two year overall survival (OS) and amputation free survival (AFS) after revascularisation in patients with chronic limb threatening ischaemia (CLTI).


      This was a retrospective analysis of prospectively collected multicentre registry data (JAPAN Critical Limb Ischaemia Database; JCLIMB). Data from 3 505 unique patients with CLTI who had undergone revascularisation from 2013 to 2017 were extracted from the JCLIMB for the analysis. The cohort was randomly divided into development (2 861 patients) and validation cohorts (644 patients). In the development cohort, multivariable risk models were constructed to predict two year OS and AFS using Cox proportional hazard regression analysis. These models were applied to the validation cohort and their performances were evaluated using Harrell’s C index and calibration plots.


      Kaplan–Meier estimates of two year OS and AFS post-revascularisation in the whole cohort were 69% and 62%, respectively. Strong predictors for OS consisted of age, activity, malignant neoplasm, chronic kidney disease (CKD), congestive heart failure (CHF), geriatric nutritional risk index (GNRI), and sex. Strong predictors for AFS included age, activity, malignant neoplasm, CKD, CHF, GNRI, body temperature, white blood cells, urgent revascularisation procedure, and sex. Prediction models for two year OS and AFS showed good discrimination with Harrell’s C indexes of 0.73 (95% confidence interval [CI] 0.69 – 0.77) and 0.72 (95% CI 0.68 – 0.76), respectively


      Prediction models for two year OS and AFS post-revascularisation in patients with CLTI were created. They can assist in determining treatment strategies and serve as risk adjustment modalities for quality benchmarking for revascularisation in patients with CLTI at each facility.


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        • Conte M.S.
        • Bradbury A.W.
        • Kolh P.
        • White J.V.
        • Dick F.
        • Fitridge R.
        • et al.
        Global vascular guidelines on the management of chronic limb-threatening ischemia.
        J Vasc Surg. 2019; 69: 3S-125S
        • Popplewell M.A.
        • Davies H.
        • Jarrett H.
        • Bate G.
        • Grant M.
        • Patel S.
        • et al.
        Bypass versus angio plasty in severe ischaemia of the leg - 2 (BASIL-2) trial: study protocol for a randomised controlled trial.
        Trials. 2016; 17: 11
        • Hunt B.D.
        • Popplewell M.A.
        • Davies H.
        • Meecham L.
        • Jarrett H.
        • Bate G.
        • et al.
        BAlloon versus Stenting in severe Ischaemia of the Leg-3 (BASIL-3): study protocol for a randomised controlled trial.
        Trials. 2017; 18: 224
        • Menard M.T.
        • Farber A.
        • Assmann S.F.
        • Choudhry N.K.
        • Conte M.S.
        • Creager M.A.
        • et al.
        Design and rationale of the best endovascular versus best surgical therapy for patients with critical limb ischemia (BEST-CLI) trial.
        J Am Heart Assoc. 2016; 5e003219
        • Biancari F.
        • Salenius J.P.
        • Heikkinen M.
        • Luther M.
        • Ylonen K.
        • Lepantalo M.
        Risk-scoring method for prediction of 30-day postoperative outcome after infrainguinal surgical revascularization for critical lower-limb ischemia: a Finnvasc registry study.
        World J Surg. 2007; 31: 217-227
        • Schanzer A.
        • Mega J.
        • Meadows J.
        • Samson R.H.
        • Bandyk D.F.
        • Conte M.S.
        Risk stratification in critical limb ischemia: derivation and validation of a model to predict amputation-free survival using multicenter surgical outcomes data.
        J Vasc Surg. 2008; 48: 1464-1471
        • Bradbury A.W.
        • Adam D.J.
        • Bell J.
        • Forbes J.F.
        • Fowkes F.G.
        • Gillespie I.
        • et al.
        Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: A survival prediction model to facilitate clinical decision making.
        J Vasc Surg. 2010; 51: 52S-68S
        • Meltzer A.J.
        • Graham A.
        • Connolly P.H.
        • Meltzer E.C.
        • Karwowski J.K.
        • Bush H.L.
        • et al.
        The Comprehensive Risk Assessment for Bypass (CRAB) facilitates efficient perioperative risk assessment for patients with critical limb ischemia.
        J Vasc Surg. 2013; 57: 1186-1195
        • Simons J.P.
        • Schanzer A.
        • Flahive J.M.
        • Osborne N.H.
        • Mills J.L.
        • Bradbury Sr., A.W.
        • et al.
        Survival prediction in patients with chronic limb-threatening ischemia who undergo infrainguinal revascularization.
        J Vasc Surg. 2019; 69: 137S-151S
        • Norgren L.
        • Hiatt W.R.
        • Dormandy J.A.
        • Nehler M.R.
        • Harris K.A.
        • Fowkes F.G.
        • et al.
        Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II).
        J Vasc Surg. 2007; 45: S5-S67
        • Miyata T.
        • Mii S.
        • Kumamaru H.
        • Takahashi A.
        • Miyata H.
        Japanese Society for Vascular Surgery Japan Critical Limb Ischemia Database Committee. Risk prediction model for early outcomes of revascularization for chronic limb-threatening ischaemia.
        Br J Surg. 2021; 108: 941-950
        • The Japanese Society for Vascular Surgery JCLIMB Committee, NCD JCLIMB Analytical Team
        JAPAN Critical Limb Ischemia Database (JCLIMB) Annual Report.
        Ann Vasc Dis. 2013; 9: 356-373
        • Miyata H.
        • Gotoh M.
        • Hashimoto H.
        • Motomura N.
        • Murakami A.
        • Tomotaki A.
        • et al.
        Challenges and prospects of a clinical database linked to the board certification system.
        Surg Today. 2014; 44: 1991-1999
        • Tomotaki A.
        • Kumamaru H.
        • Hashimoto H.
        • Takahashi A.
        • Ono M.
        • Iwanaka T.
        • et al.
        Evaluating the quality of data from the Japanese National Clinical Database 2011 via a comparison with regional government report data and medical charts.
        Surg Today. 2019; 49: 65-71
        • Bouillanne O.
        • Morineau G.
        • Dupont C.
        • Coulombel I.
        • Vincent J.P.
        • Nicolis I.
        • et al.
        Geriatric Nutritional Risk Index: A new index for evaluating at-risk elderly medical patients.
        Am J Clin Nutr. 2005; 82: 777-783
        • Yamada K.
        • Furuya R.
        • Takita T.
        • Maruyama Y.
        • Yamaguchi Y.
        • Ohkawa S.
        • et al.
        Simplified nutritional screening tools for patients on maintenance hemodialysis.
        Am J Clin Nutr. 2008; 87: 106-113
        • Azuma N.
        • Takahara M.
        • Kodama A.
        • Soga Y.
        • Terashi H.
        • Tazaki J.
        • et al.
        Predictive model for mortality risk including the wound, ischemia, foot infection classification in patients undergoing revascularization for critical limb ischemia.
        Circ Cardiovasc Interv. 2019; 12e008015