Abstract 18132: Utility of Risk Stratification to Predict Early Mortality in Patients with Critical Limb Ischemia
Background: Revascularization is the optimal treatment to avoid major amputation for critical limb ischemia (CLI) patients. It has been also reported that the presence of CLI was strongly associated with mortality. Previous study suggests that CLI patients who are unlikely to live 2 years are probably better served by Endovascular treatment (EVT) first revascularization. In this study, we sought to investigate the predictors of early mortality in patients with CLI and to detect the patients with an estimated life expectancy of 2 years or less.
Methods: This study was a multicenter retrospective observational study of prospective maintained database. From March 2004 to June 2011, total of 884 patients with CLI who underwent angioplasty for de novo isolated below-the-knee (BTK) artery disease were enrolled. Outcome measure was all-cause mortality within two years.
Results: Mean follow-up period was 589 ± 527 days. Cox multivariate regression analysis showed that body mass index (BMI)<18, serum albumin level<3g/dl, non-ambulatory status, ejection fraction (EF)<45%, and presence of cerebro-vascular disease (CVD) were positively associated with all-cause death within 2 years. The sum of number of risk factors was used to classify patients into three groups: low-risk group (0-1 risk factor, n=605), moderate-risk group (2 risk factors, n=194) and high-risk group (3-5 risk factors, n=85). Kaplan-Meier survival curve showed that freedom from all-cause death at two years was 79.0% in low-risk group, 50.1% in moderate-risk group and 30.1% in high-risk group.
Conclusion: In patients with CLI caused by isolated BTK disease, BMI<18, serum albumin level<3g/dl, non-ambulatory status, EF<45%, and presence of CVD were the independent predictors of early mortality. Patients who have more than two of these risk factors may indicate EVT first revascularization.
- © 2012 by American Heart Association, Inc.