Abstract 18064: Prognostic Risk Index for One Year Morbimortality in Hospitalized Patients with Peripheral Artery Disease
Background. Risk stratification in peripheral arterial disease (PAD) may provide the basis for optimal management strategies in patients. This study aimed to develop a prognostic risk index for one-year morbimortality, in patients with severe PAD.
Methods and results. Factors associated with morbimortality (total mortality, non-fatal MI or non-fatal stroke) were determined using data from the prospective, multicentre COPART register, including consecutive patients hospitalized for PAD in 3 university hospitals in Southwestern France. A risk score was constructed in a derivation cohort using the beta regression coefficient obtained in the final model of a descending step-by-step logistic regression analysis. The score was then tested on a validation cohort. We analyzed the data of 1,157 patients at hospital discharge: 640 in the derivation cohort and 517 in the validation cohort. At one year, morbimortality rate were respectively 19.2% and 20.3%. The index included the following factors (weight points): age ≥75<85 (+2), ≥85 years (+3); previous history of myocardial infarction (+1); eGFR according to MDRD equation ≤30 (+1.5), >30≤60 ml/min-11.73m-2 (+1); ankle-brachial index <0.3 (+2), ≥0.3<0.5 (+1.5) and >1.3 (+2); CRP ≥69mg/l (+2); association of statins, antiplatelet agents, renin-angiotensin system inhibitors (-1.5). Morbimortality rates increased significantly with the risk index in the derivation cohort: low risk (≤0 point): 2%; medium (>0≤2): 12.8%; high (>2<4.5): 23%; very high (≥4.5): 42.2%. The prognostic risk index appeared to be discriminating in both cohorts (C-statistic 0.76 and 0.74). Calibration was satisfying, no significant differences were found between the observed and calculated morbimortality rates in the validation cohort, using our prognostic risk index (Hosmer-Lemeshow χ2 p= 0.65).
Conclusions. This prognostic risk index is a tool for risk stratification in patients with PAD and may be helpful for patient counselling and medical decision making.
- © 2011 by American Heart Association, Inc.