BACKGROUND: Prognostic information in peripheral arterial disease (PAD) may provide the basis for optimal management strategies at an early stage. This study aimed to develop a prognostic risk index for long-term mortality in patients with PAD. METHODS: In a single-center observational cohort study, 2642 patients with an ankle-brachial index of 0.90 or lower were randomly divided into derivation (n = 1332) and validation (n = 1310) cohorts. Cox regression analysis with stepwise backward elimination identified predictors of 1-year, 5-year, and 10-year mortality in the derivation cohort. Weighted points were assigned to each predictor. Index discrimination was determined in both the derivation and validation cohorts. RESULTS: During 10 years of follow-up, 42.2% and 40.4% of patients died in the derivation and validation cohorts, respectively. The risk index for 10-year mortality (+ points) included renal dysfunction (+12), heart failure (+7), ST-segment changes (+5), age greater than 65 years (+5), hypercholesterolemia (+5), ankle-brachial index lower than 0.60 (+4), Q-waves (+4), diabetes (+3), cerebrovascular disease (+3), and pulmonary disease (+3). Statins (-6), aspirin (-4), and beta-blockers (-4) were associated with reduced 10-year mortality. Patients were stratified into low (<0 points), low-intermediate (0-5 points), high-intermediate (6-9 points), and high (>9 points) risk categories, according to risk score. Ten-year mortality rates were 22.1%, 32.2%, 45.8%, and 70.4%, respectively (P < .001) and comparable to mortality in the validation cohort. C statistics demonstrated good discrimination in both the derivation (0.72) and validation cohorts (0.73). CONCLUSIONS: A prognostic risk index for long-term mortality stratified patients with PAD into different risk categories. This may be useful for risk stratification, patient counseling, and medical decision making.
BACKGROUND: Prognostic information in peripheral arterial disease (PAD) may provide the basis for optimal management strategies at an early stage. This study aimed to develop a prognostic risk index for long-term mortality in patients with PAD. METHODS: In a single-center observational cohort study, 2642 patients with an ankle-brachial index of 0.90 or lower were randomly divided into derivation (n = 1332) and validation (n = 1310) cohorts. Cox regression analysis with stepwise backward elimination identified predictors of 1-year, 5-year, and 10-year mortality in the derivation cohort. Weighted points were assigned to each predictor. Index discrimination was determined in both the derivation and validation cohorts. RESULTS: During 10 years of follow-up, 42.2% and 40.4% of patients died in the derivation and validation cohorts, respectively. The risk index for 10-year mortality (+ points) included renal dysfunction (+12), heart failure (+7), ST-segment changes (+5), age greater than 65 years (+5), hypercholesterolemia (+5), ankle-brachial index lower than 0.60 (+4), Q-waves (+4), diabetes (+3), cerebrovascular disease (+3), and pulmonary disease (+3). Statins (-6), aspirin (-4), and beta-blockers (-4) were associated with reduced 10-year mortality. Patients were stratified into low (<0 points), low-intermediate (0-5 points), high-intermediate (6-9 points), and high (>9 points) risk categories, according to risk score. Ten-year mortality rates were 22.1%, 32.2%, 45.8%, and 70.4%, respectively (P < .001) and comparable to mortality in the validation cohort. C statistics demonstrated good discrimination in both the derivation (0.72) and validation cohorts (0.73). CONCLUSIONS: A prognostic risk index for long-term mortality stratified patients with PAD into different risk categories. This may be useful for risk stratification, patient counseling, and medical decision making.
Authors: Shu Huang; Seonkyeong Yang; Shirly Ly; Ryan H Yoo; Wei-Hsuan Lo-Ciganic; Michael T Eadon; Titus Schleyer; Elizabeth Whipple; Khoa Anh Nguyen Journal: Eur J Clin Pharmacol Date: 2022-06-03 Impact factor: 3.064
Authors: Razvan Anghel; Cristina Andreea Adam; Ovidiu Mitu; Dragos Traian Marius Marcu; Viviana Onofrei; Mihai Roca; Alexandru Dan Costache; Radu Stefan Miftode; Grigore Tinica; Florin Mitu Journal: Diagnostics (Basel) Date: 2022-06-20
Authors: Adelaide M Arruda-Olson; Homam Moussa Pacha; Naveed Afzal; Sara Abram; Bradley R Lewis; Iyad Isseh; Raad Haddad; Christopher G Scott; Kent Bailey; Hongfang Liu; Thom W Rooke; Iftikhar J Kullo Journal: Vasc Med Date: 2017-10-25 Impact factor: 3.239
Authors: Andres Schanzer; Jessica Mega; Judith Meadows; Russell H Samson; Dennis F Bandyk; Michael S Conte Journal: J Vasc Surg Date: 2008-12 Impact factor: 4.268
Authors: I Vaartjes; G J de Borst; J B Reitsma; A de Bruin; F L Moll; D E Grobbee; M L Bots Journal: BMC Cardiovasc Disord Date: 2009-08-28 Impact factor: 2.298