Objective
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).
Methods
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.
Results
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
Conclusion
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Vascular and Endovascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global vascular guidelines on the management of chronic limb-threatening ischemia.J Vasc Surg. 2019; 69: 3S-125S
- 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
- BAlloon versus Stenting in severe Ischaemia of the Leg-3 (BASIL-3): study protocol for a randomised controlled trial.Trials. 2017; 18: 224
- 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
- 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
- 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
- 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
- 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
- Survival prediction in patients with chronic limb-threatening ischemia who undergo infrainguinal revascularization.J Vasc Surg. 2019; 69: 137S-151S
- Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II).J Vasc Surg. 2007; 45: S5-S67
- 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
- JAPAN Critical Limb Ischemia Database (JCLIMB) Annual Report.Ann Vasc Dis. 2013; 9: 356-373
- Challenges and prospects of a clinical database linked to the board certification system.Surg Today. 2014; 44: 1991-1999
- 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
- Geriatric Nutritional Risk Index: A new index for evaluating at-risk elderly medical patients.Am J Clin Nutr. 2005; 82: 777-783
- Simplified nutritional screening tools for patients on maintenance hemodialysis.Am J Clin Nutr. 2008; 87: 106-113
- 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
Article info
Publication history
Published online: June 06, 2022
Accepted:
May 29,
2022
Received:
December 25,
2021
Identification
Copyright
© 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.