Predictive Model for Mortality Risk Including the Wound, Ischemia, Foot Infection Classification in Patients Undergoing Revascularization for Critical Limb Ischemia

Azuma, Nobuyoshi; Takahara, Mitsuyoshi; Kodama, Akio; Soga, Yoshimitsu; Terashi, Hiroto; Tazaki, Junichi; Yamaoka, Terutoshi; Koya, Atsuhiro; Iida, Osamu

doi:10.1161/circinterventions.119.008015

Cited by 37 publications

(25 citation statements)

References 31 publications

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“…In contrast, somewhat surprisingly, DM was not significantly associated with the mortality risk in this study population ( P = 0.72) (15) . The lack of a significant association between DM and mortality risk was thereafter re-confirmed in our multicenter retrospective study of 995 patients with CLTI undergoing EVT (16) , our multicenter retrospective study of 459 patients with CLTI undergoing either EVT or surgical reconstruction (17) , and our multicenter prospective study of 520 patients with CLTI undergoing either EVT or surgical reconstruction (all P > 0.05) (18) . These findings are in contrast with the common knowledge that DM increases the mortality risk in patients with other cardiovascular diseases, including CAD (21) , (22) .…”

Section: Clinical Features Of Clti #1: Prognosissupporting

confidence: 53%

“…One major clinical factor that is associated with the mortality risk in patients with CLTI is age; older patients with CLTI are at a higher mortality risk than younger patients with CLTI (15) , (16) , (17) , (18) . In other words, younger patients with CLTI live longer than older patients with CLTI, which would be no surprise.…”

Section: Clinical Features Of Clti #1: Prognosismentioning

confidence: 99%

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Diabetes Mellitus and Lower Extremity Peripheral Artery Disease

Takahara

2021

JMA J

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Lower extremity peripheral artery disease, or often simply called peripheral artery disease (PAD), is a common cardiovascular disease, as coronary artery disease is. Atherosclerotic disease of the arteries of the lower extremity, or arteriosclerosis obliterans, accounts for the vast majority of PAD today. Rest pain, nonhealing ulcers, and gangrenes associated with chronic ischemia (i.e., Fontaine stage III and IV or Rutherford category 4 to 6) are referred to as chronic limb-threatening ischemia (CLTI), formally called critical limb ischemia (CLI). This narrative review focuses on atherosclerotic PAD, especially CLTI, mainly highlighting its link with diabetes mellitus (DM). This article will first overview the clinical impact of DM in patients with symptomatic PAD and that of symptomatic PAD in patients with DM, followed by the clinical features of CLTI, which will be discussed from a viewpoint of its prognosis, patient profile, onset, and seasonality. DM poses a great clinical impact on CLTI, and vice versa. Patient profile appears different between DM patients complicated with CLTI and the general population with DM. Furthermore, although CLTI is pathologically rooted in atherosclerosis as is acute coronary syndrome (ACS), CLTI has considerably different clinical features compared with ACS. CLTI has an extremely poor prognosis even after revascularization, and there is ample room for improvement in terms of its prognosis. Some measures might be needed in healthcare and clinical settings before revascularization: e.g., DM control and regular ischemia risk evaluation before CLTI onset, proper diagnosis at CLTI onset, and prompt referral to a vascular specialist after CLTI onset, although its evidence is still scanty. Piling up evidence of patients with CLTI, by patients with CLTI, and for patients with CLTI is needed.

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Section: Clinical Features Of Clti #1: Prognosissupporting

confidence: 53%

Section: Clinical Features Of Clti #1: Prognosismentioning

confidence: 99%

Diabetes Mellitus and Lower Extremity Peripheral Artery Disease

Takahara

2021

JMA J

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“…However, current BMI was associated with the mortality risk independently of the CONUT score, whereas the CONUT score, but not current BMI, had a significant association with limbrelated prognosis. BMI might reflect some different aspects of systemic conditions than laboratory nutritional assessments 24) .…”

Section: Discussionmentioning

confidence: 99%

Current and Past Obesity in Japanese Patients with Critical Limb Ischemia Undergoing Revascularization

Takahara

Iida

Soga³

et al. 2021

JAT

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Aim: Recent studies suggested that past history of obesity or maximum body mass index (BMI) in the past was a strong prognostic predictor in a general population. The current study aimed to survey the distribution of current and maximum BMIs and to investigate their prognostic impact in patients with critical limb ischemia (CLI), whose prognosis was poor even after revascularization. Methods:We analyzed a database of a prospective, multicenter registry in Japan, including 499 CLI patients undergoing revascularization. Their current and maximum BMIs were surveyed at registration. The distribution and the impact on the prognosis were explored. Results:The estimated means (95% confidence intervals) of current and maximum BMIs were respectively 22.0 (21.7 to 22.3) and 25.3 (24.8 to 25.8) kg/m 2 ; the difference was 3.3 (2.9 to 3.7) kg/m 2 . The prevalence of current obesity (BMI ≥ 25 kg/m 2 ) was 18% (15% to 22%), whereas 48% (43% to 53%) had ever been obese (maximum BMI ≥ 25 kg/m 2 ). Past obesity was not rare even in currently lean subjects (BMI 18.5 kg/m 2 ), with the prevalence of 18% (7% to 29%). Current BMI, but not maximum BMI, was associated with the mortality risk; the adjusted hazard ratios per 5 kg/m 2 increase were 0.61 [0.46, 0.81] (P 0.001) and 1.07 [0.87, 1.31] (P 0.55), respectively. Conclusion:The prevalence of current obesity was as low as 18% (15% to 22%) in Japanese CLI patients undergoing revascularization, whereas about a half were formerly obese. Maximum BMI was not independently associated with the mortality risk in the population.

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“…Few prognostic scores are available in the setting of CLI. Recently, a predictive model for mortality risk in CLI patients has been derived from the SPINACH (surgical reconstruction vs. peripheral intervention in patients with critical limb ischemia) study (7). The model did not include any serum biomarker and had a good predictive power at 2 years.…”

Section: Spinach Study Scorementioning

confidence: 99%

“…Diabetic patients have a high chance to develop the most advanced form of PAD, namely, critical limb ischemia (CLI) with foot lesions (CLI with tissue loss or diabetic foot). Cardiac adverse events are common in these patients, independently of a concomitant diagnosis of CAD, with cardiac death being the most common cause of mortality (6,7). The exacerbation of PAD or the need of procedures further increase the risk of cardiac adverse events (8).…”

Section: Introductionmentioning

confidence: 99%

High-Sensitivity Cardiac Troponin Predicts Major Cardiovascular Events in Diabetic Patients With Critical Limb Ischemia and Foot Lesions

Cimaglia

Paola

Carone

et al. 2021

Front. Cardiovasc. Med.

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Background: Diabetic patients with critical limb ischemia (CLI) and foot lesions show a poor prognosis. Optimal risk stratification to guide tailored intervention is still uncertain. The aim of the present study was to assess the prognostic role of high-sensitivity cardiac troponin T (hs-TnT) in such a high-risk population.Methods and Results: Clinical, laboratory, and interventional data, as well as the SPINACH score, were collected. Hs-TnT was measured at hospital admission. All patients were followed up for at least 1 year. The primary endpoint was the cumulative occurrence of major cardiovascular events (MACEs, all-cause death, myocardial infarction, or stroke). The secondary endpoint was all-cause mortality. Overall, 618 patients were included and followed for a median of 981 (557–1,325) days. Diagnosis of coronary artery disease (CAD) was established in 270 (43.7%) patients. Median hs-TnT at admission was 31 (20–59) ng/L, with 525 (85%) patients over the upper reference limit. Hs-TnT values were significantly higher in patients with established CAD (39 vs. 29 ng/L, p < 0.01). Hs-TnT was an independent predictor of MACE (HR 2.440, 95% CI 1.706–3.489, p < 0.001). The best cut-offs were 40 ng/L (AUC 0.711) for patients with established CAD and 25 ng/L (AUC 0.725) for those without. Hs-TnT emerged also as an independent predictor of all-cause mortality. The addition of hs-TnT improved prognostic value of the SPINACH score.Conclusions: Hs-TnT is a powerful biomarker for prognostic stratification of diabetic CLI patients with foot lesions. This is confirmed independently to CAD diagnosis and permits the identification of higher risk patients requiring tailored intervention.

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Predictive Model for Mortality Risk Including the Wound, Ischemia, Foot Infection Classification in Patients Undergoing Revascularization for Critical Limb Ischemia

Cited by 37 publications

References 31 publications

Diabetes Mellitus and Lower Extremity Peripheral Artery Disease

Diabetes Mellitus and Lower Extremity Peripheral Artery Disease

Current and Past Obesity in Japanese Patients with Critical Limb Ischemia Undergoing Revascularization

High-Sensitivity Cardiac Troponin Predicts Major Cardiovascular Events in Diabetic Patients With Critical Limb Ischemia and Foot Lesions

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