Influence of frailty on treatment outcomes after revascularization in patients with critical limb ischemia

Koichi Morisaki, Terutoshi Yamaoka, Kazuomi Iwasa, Takahiro Ohmine

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective It is unclear whether frailty adversely affects treatment outcomes in patients with critical limb ischemia (CLI). The aim of this study was to investigate the influence of frailty on CLI patients after revascularization. Methods Patients undergoing infrapopliteal revascularization between 2007 and 2015 were retrospectively analyzed. The patient was defined as CLI frail when two or more of the following were present: low Geriatric Nutritional Risk Index, low skeletal muscle mass index, or nonambulatory status. The primary study end point was 2-year amputation-free survival (AFS). To analyze the diagnostic criteria of frailty, the CLI Frailty Index was compared with a modified Frailty Index using a receiver operating characteristic area under the curve. The secondary end points were occurrence of Clavien-Dindo class IV complications and 30-day or hospital mortality. Results During the study period, 266 patients and 325 limbs underwent infrapopliteal revascularization. The AFS rate 1 year and 2 years after revascularization was 81.8% and 72.9% for the CLI frail− group vs 45.8% and 34.0% for the CLI frail+ group (P <.001), respectively. Multivariate analysis revealed that the CLI Frailty Index (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.78-4.32; P <.001) and hemodialysis (HR, 1.72; 95% CI, 1.11-2.69; P =.02) were risk factors for AFS 2 years after revascularization. The CLI Frailty Index area under the curve was 0.72 compared with 0.63 for the modified Frailty Index (P =.01). Only the CLI Frailty Index was found to be a risk factor for morbidity (HR, 3.21; 95% CI, 1.45-7.27; P =.004) and 30-day or hospital mortality (HR, 6.32; 95% CI, 1.43-43.7; P =.01). Conclusions The CLI Frailty Index is a risk factor for 2-year AFS in CLI patients after revascularization. This result could prove useful for prognostic prediction and decision-making in selection of bypass surgery or endovascular therapy as a first treatment strategy.

Original languageEnglish
Pages (from-to)1758-1764
Number of pages7
JournalJournal of Vascular Surgery
Volume66
Issue number6
DOIs
Publication statusPublished - Dec 1 2017

Fingerprint

Ischemia
Extremities
Amputation
Confidence Intervals
Hospital Mortality
Area Under Curve
Survival
Nutrition Assessment
ROC Curve
Geriatrics
Renal Dialysis
Decision Making
Skeletal Muscle
Multivariate Analysis
Survival Rate
Morbidity
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Influence of frailty on treatment outcomes after revascularization in patients with critical limb ischemia. / Morisaki, Koichi; Yamaoka, Terutoshi; Iwasa, Kazuomi; Ohmine, Takahiro.

In: Journal of Vascular Surgery, Vol. 66, No. 6, 01.12.2017, p. 1758-1764.

Research output: Contribution to journalArticle

Morisaki, Koichi ; Yamaoka, Terutoshi ; Iwasa, Kazuomi ; Ohmine, Takahiro. / Influence of frailty on treatment outcomes after revascularization in patients with critical limb ischemia. In: Journal of Vascular Surgery. 2017 ; Vol. 66, No. 6. pp. 1758-1764.
@article{fcc07a839d5d4caeb5fb6aa03adeb333,
title = "Influence of frailty on treatment outcomes after revascularization in patients with critical limb ischemia",
abstract = "Objective It is unclear whether frailty adversely affects treatment outcomes in patients with critical limb ischemia (CLI). The aim of this study was to investigate the influence of frailty on CLI patients after revascularization. Methods Patients undergoing infrapopliteal revascularization between 2007 and 2015 were retrospectively analyzed. The patient was defined as CLI frail when two or more of the following were present: low Geriatric Nutritional Risk Index, low skeletal muscle mass index, or nonambulatory status. The primary study end point was 2-year amputation-free survival (AFS). To analyze the diagnostic criteria of frailty, the CLI Frailty Index was compared with a modified Frailty Index using a receiver operating characteristic area under the curve. The secondary end points were occurrence of Clavien-Dindo class IV complications and 30-day or hospital mortality. Results During the study period, 266 patients and 325 limbs underwent infrapopliteal revascularization. The AFS rate 1 year and 2 years after revascularization was 81.8{\%} and 72.9{\%} for the CLI frail− group vs 45.8{\%} and 34.0{\%} for the CLI frail+ group (P <.001), respectively. Multivariate analysis revealed that the CLI Frailty Index (hazard ratio [HR], 2.77; 95{\%} confidence interval [CI], 1.78-4.32; P <.001) and hemodialysis (HR, 1.72; 95{\%} CI, 1.11-2.69; P =.02) were risk factors for AFS 2 years after revascularization. The CLI Frailty Index area under the curve was 0.72 compared with 0.63 for the modified Frailty Index (P =.01). Only the CLI Frailty Index was found to be a risk factor for morbidity (HR, 3.21; 95{\%} CI, 1.45-7.27; P =.004) and 30-day or hospital mortality (HR, 6.32; 95{\%} CI, 1.43-43.7; P =.01). Conclusions The CLI Frailty Index is a risk factor for 2-year AFS in CLI patients after revascularization. This result could prove useful for prognostic prediction and decision-making in selection of bypass surgery or endovascular therapy as a first treatment strategy.",
author = "Koichi Morisaki and Terutoshi Yamaoka and Kazuomi Iwasa and Takahiro Ohmine",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.jvs.2017.04.048",
language = "English",
volume = "66",
pages = "1758--1764",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Influence of frailty on treatment outcomes after revascularization in patients with critical limb ischemia

AU - Morisaki, Koichi

AU - Yamaoka, Terutoshi

AU - Iwasa, Kazuomi

AU - Ohmine, Takahiro

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Objective It is unclear whether frailty adversely affects treatment outcomes in patients with critical limb ischemia (CLI). The aim of this study was to investigate the influence of frailty on CLI patients after revascularization. Methods Patients undergoing infrapopliteal revascularization between 2007 and 2015 were retrospectively analyzed. The patient was defined as CLI frail when two or more of the following were present: low Geriatric Nutritional Risk Index, low skeletal muscle mass index, or nonambulatory status. The primary study end point was 2-year amputation-free survival (AFS). To analyze the diagnostic criteria of frailty, the CLI Frailty Index was compared with a modified Frailty Index using a receiver operating characteristic area under the curve. The secondary end points were occurrence of Clavien-Dindo class IV complications and 30-day or hospital mortality. Results During the study period, 266 patients and 325 limbs underwent infrapopliteal revascularization. The AFS rate 1 year and 2 years after revascularization was 81.8% and 72.9% for the CLI frail− group vs 45.8% and 34.0% for the CLI frail+ group (P <.001), respectively. Multivariate analysis revealed that the CLI Frailty Index (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.78-4.32; P <.001) and hemodialysis (HR, 1.72; 95% CI, 1.11-2.69; P =.02) were risk factors for AFS 2 years after revascularization. The CLI Frailty Index area under the curve was 0.72 compared with 0.63 for the modified Frailty Index (P =.01). Only the CLI Frailty Index was found to be a risk factor for morbidity (HR, 3.21; 95% CI, 1.45-7.27; P =.004) and 30-day or hospital mortality (HR, 6.32; 95% CI, 1.43-43.7; P =.01). Conclusions The CLI Frailty Index is a risk factor for 2-year AFS in CLI patients after revascularization. This result could prove useful for prognostic prediction and decision-making in selection of bypass surgery or endovascular therapy as a first treatment strategy.

AB - Objective It is unclear whether frailty adversely affects treatment outcomes in patients with critical limb ischemia (CLI). The aim of this study was to investigate the influence of frailty on CLI patients after revascularization. Methods Patients undergoing infrapopliteal revascularization between 2007 and 2015 were retrospectively analyzed. The patient was defined as CLI frail when two or more of the following were present: low Geriatric Nutritional Risk Index, low skeletal muscle mass index, or nonambulatory status. The primary study end point was 2-year amputation-free survival (AFS). To analyze the diagnostic criteria of frailty, the CLI Frailty Index was compared with a modified Frailty Index using a receiver operating characteristic area under the curve. The secondary end points were occurrence of Clavien-Dindo class IV complications and 30-day or hospital mortality. Results During the study period, 266 patients and 325 limbs underwent infrapopliteal revascularization. The AFS rate 1 year and 2 years after revascularization was 81.8% and 72.9% for the CLI frail− group vs 45.8% and 34.0% for the CLI frail+ group (P <.001), respectively. Multivariate analysis revealed that the CLI Frailty Index (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.78-4.32; P <.001) and hemodialysis (HR, 1.72; 95% CI, 1.11-2.69; P =.02) were risk factors for AFS 2 years after revascularization. The CLI Frailty Index area under the curve was 0.72 compared with 0.63 for the modified Frailty Index (P =.01). Only the CLI Frailty Index was found to be a risk factor for morbidity (HR, 3.21; 95% CI, 1.45-7.27; P =.004) and 30-day or hospital mortality (HR, 6.32; 95% CI, 1.43-43.7; P =.01). Conclusions The CLI Frailty Index is a risk factor for 2-year AFS in CLI patients after revascularization. This result could prove useful for prognostic prediction and decision-making in selection of bypass surgery or endovascular therapy as a first treatment strategy.

UR - http://www.scopus.com/inward/record.url?scp=85021183852&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021183852&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2017.04.048

DO - 10.1016/j.jvs.2017.04.048

M3 - Article

VL - 66

SP - 1758

EP - 1764

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 6

ER -