Abstract
BackgroundTwo-year longevity is a crucial consideration in revascularization strategies for patients with symptomatic lower extremity arterial disease (LEAD). However, factors associated with 2-year longevity and risk stratification in octogenarians or nonagenarians have been underreported.ObjectiveThis paper aims to investigate the associated variables and stratify the 2-year prognosis in older patients with LEAD.MethodsWe performed logistic regression and association rule mining based on the Apriori algorithm to discover independent variables and validate their associations with 2-year longevity. Malnutrition, inflammation, and stroke factors were identified. C statistics and Kaplan-Meier analysis were used to assess the impact of different numbers of malnutrition, inflammation, and stroke factors on 2-year longevity.ResultsWe recruited a total of 232 octogenarians or nonagenarians (mean age 85 years, SD 4.2 years) treated with endovascular therapy. During the study period, 81 patients died, and 27 of those (33%) died from a cardiac origin within 2 years. Association rules analysis showed the interrelationships between 2-year longevity and the neutrophil-lymphocyte ratio (NLR) and nutritional status as determined by the Controlling Nutritional Status (CONUT) score or Geriatric Nutritional Risk Index (GNRI). The cut-off values of NLR, GNRI, and CONUT were ≥3.89, ≤90.3, and >3, respectively. The C statistics for the predictive power for 2-year longevity were similar between the CONUT score and the GNRI-based models (0.773 vs 0.760; P=.57). The Kaplan-Meier analysis showed that 2-year longevity was worse as the number of malnutrition, inflammation, and stroke factors increased from 0 to 3 in both the GNRI-based model (92% vs 68% vs 46% vs 12%, respectively; P<.001) and the CONUT score model (87% vs 75% vs 49% vs 10%, respectively; P<.001). The hazard ratio between those with 3 factors and those without was 18.2 (95% CI 7.0-47.2; P<.001) in the GNRI and 13.6 (95% CI 5.9-31.5; P<.001) in the CONUT score model.ConclusionsThis study demonstrated the association and crucial role of malnutrition, inflammation, and stroke factors in assessing 2-year longevity in older patients with LEAD. Using this simple risk score might assist clinicians in selecting the appropriate treatment.
Highlights
With the aging of the population and improvements in the quality of medical care, physicians encounter an ever-increasing number of older patients with advanced forms of lower extremity arterial disease (LEAD) [1,2]
2-year longevity is a crucial consideration in revascularization strategies in patients with symptomatic LEAD, this measure should be used with caution in older people with an inherently shorter life expectancy, and the factors associated with 2-year longevity and the prognostic stratification in these patients are unclear
Data were extracted from the Tzuchi Registry of Endovascular Intervention for Peripheral Artery Disease, which is a single-center observational registry of patients who have undergone endovascular therapy (EVT) for LEAD starting from July 2005
Summary
With the aging of the population and improvements in the quality of medical care, physicians encounter an ever-increasing number of older patients with advanced forms of lower extremity arterial disease (LEAD) [1,2]. The results of the Bypass Versus Angioplasty in Severe Ischaemia of the Leg (BASIL) study [3] and the American Heart Association and American College of Cardiology guidelines [4] suggested bypass surgery as an appropriate first-line revascularization procedure for chronic limb-threatening ischemia (CLTI) in patients with a life expectancy of more than 2 years. 2-year longevity is a crucial consideration in revascularization strategies in patients with symptomatic LEAD, this measure should be used with caution in older people with an inherently shorter life expectancy, and the factors associated with 2-year longevity and the prognostic stratification in these patients are unclear. Two-year longevity is a crucial consideration in revascularization strategies for patients with symptomatic lower extremity arterial disease (LEAD). Factors associated with 2-year longevity and risk stratification in octogenarians or nonagenarians have been underreported
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