Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysis

Abstract

Objectives Among changes in demographics, aging is the most relevant cardiovascular risk factor. The prevalence of peripheral artery disease (PAD) is high in elderly patients and is associated with a worse prognosis. Despite optimal treatments, mortality in the high-risk population of octo- and nonagenarians with PAD remains excessive, and predictive factors need to be identified. The objective of this study was to investigate predictors of mortality in octo- and nonagenarians with PAD. Methods Cases of treated octo- and nonagenarians, including the clinical characteristics and markers of myocardial injury and heart failure, were studied retrospectively with respect to all-cause mortality. Hazard ratios [HR] were calculated and survival was analyzed by Kaplan-Meyer curves and receiver operating characteristic curved were assessed for troponin-ultra and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and chronic limb-threatening ischemia (CLTI). Results A total of 123 octo- and nonagenarians admitted for PAD were eligible. The troponin level was the major predictor of all-cause mortality (HR: 4.6, 95% confidence interval [CI]: 1.4–15.3), followed by the NT-proBNP level (HR: 3.9, 95% CI 1.8–8.8) and CLTI (HR: 3.1, 95% CI 1.6–5.9). Multivariate regression revealed that each increment of 1 standard deviation in log troponin and log NT-proBNP was associated with a 2.7-fold (95% CI 1.8–4.1) and a 1.9-fold (95% CI 1.2–2.9) increased risk of all-cause death. Receiver operating characteristic curve analysis using a combination of all predictors yielded an improved area under the curve of 0.888. In a control group of an equal number of younger individuals, only NT-proBNP (HR: 4.2, 95% CI 1.2–14.1) and CLTI (HR: 6.1, 95% CI 1.6–23.4) were predictive of mortality. Conclusion Our study demonstrates that cardiovascular biomarkers and CLTI are the primary predictors of increased mortality in elderly PAD patients. Further risk stratification through biomarkers in this high-risk population of octo- and nonagenarians with PAD is necessary.

Mortality of older persons with and without abnormalities in the physical examination of arterial system

“…This underlines the extent of risk associated with developed PAD [14]. On the other hand, in the group with ABI ≥ 0.9, not only the classic risk factors such as age, male sex, smoking, higher SBP, but also the levels of IL-6 and NT-proBNP increased the risk of death which is in line with the results of earlier studies [20][21][22][23][24]. This may indicate a potential role of inflammageing and subclinical circulatory failure as clinical modifiers of PAD [24,25].…”

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients—A Review: Part I—Epidemiology, Risk Factors, and Atherosclerosis-Related Diversities in Elderly Patients

“…Another study investigated the factors that influence the risk of death in PAD patients over the age of 80 and 90 years [ 113 ]. One-year mortality was 25% (35/123 patients) above the age of 80 years compared to 10% (13/123 patients) in the group of patients under the age of 80 years.…”

“…One-year mortality was 25% (35/123 patients) above the age of 80 years compared to 10% (13/123 patients) in the group of patients under the age of 80 years. In the group of PAD patients aged 80 years and above, it was found that the concentration of cardiovascular markers such as troponin > 40 ng/L (HR: 4.6; 95% CI: 1.4–15.3) and NT-pro-BNP > 450 pg/mL (HR: 3.9; 95% CI 1.8–8.8) and the occurrence of MALE (HR: 3.1; 95% CI 1.6–5.9) were strong predictors of patient death [ 113 ]. Features of ischemia, HF, and MALE determine the survival of this group of patients.…”

Income-Related Peripheral Artery Disease Treatment: A Nation-Wide Analysis from 2009–2018

“…According to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II), CLTI is defined as chronic ischemic rest pain, ulceration or gangrene due to PAD [14]. CLTI is associated with an increased mortality, a high risk of major amputation and impaired quality of life [15][16][17][18]. Frequent complications include infections and gangrene, as well as major amputations.…”