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BMI, sex, lesion length predictive of outcomes from ischemia intervention
In a new study, factors including BMI, sex and lesion length were significantly associated with adverse events after intervention for limb-threatening ischemia of the infrapopliteal vessels.
Researchers incorporated preoperative and follow-up data collected from the Vascular Quality Initiative (VQI) on patients with limb-threatening ischemia of the infrapopliteal vessels to generate separate models for outcomes from open infrainguinal bypass and peripheral vascular intervention. Evaluable patients underwent open surgery (n = 5,264) or peripheral vascular intervention (n = 5,252) between 2003 and August 2014. Follow-up data were collected from 3,036 open bypass recipients and 1,319 who underwent peripheral vascular intervention for the present analysis.
The primary outcomes were major adverse limb events and amputation-free survival. Variables found to be associated with the primary outcomes in univariate analysis were entered into multivariate analyses conducted using generalized linear modeling.
The two groups differed with regard to several factors, including the prevalence of black race (13.2% in the open-surgery group vs. 18.9% in the peripheral vascular intervention group; P < .001), current smoking (35% vs. 18.4%; P < .001), diabetes (58.9% vs. 75.1%; P < .001), need for urgent revascularization (27.9% vs. 24.3%; P = .014) and tissue loss (67.6% vs. 83.6%; P < .001), among others.
According to the reduced generalized linear model, factors associated with the greatest adverse effect on major adverse limb events among patients who underwent open surgery included female sex (OR = 1.57; 95% CI, 1.32-1.86), prior major amputation (OR = 1.61; 95% CI, 1.19-2.19), living at a nursing home (OR = 1.61; 95% CI, 1.04-2.47) and American Society of Anesthesiologists class 4 or 5 (OR = 1.76; 95% CI, 1.1-2.81). Among those who underwent peripheral vascular intervention, a lesion length between 10 cm and 15 cm (OR = 0.32; 95% CI, 0.13-0.79), receiving treatment for three or more arteries (OR = 2.24; 95% CI, 1.53-3.27), and a Trans-Atlantic Inter-Society Consensus (TASC) classification other than A (OR = 0.52; 95% CI, 0.24-1.14 for TASC A) had the strongest effect on major adverse limb events.
Factors associated with the greatest effect on amputation-free survival included low BMI (OR = 1.85; 95% CI, 1.44-2.37 for BMI of 20-30 kg/m2), dialysis (OR = 0.34; 95% CI, 0.25-0.46) and the lack of a great saphenous vein as a conduit (OR = 1.67; 95% CI, 1.34-2.08 for great saphenous vein graft type) in the open-surgery group; and low BMI (OR = 2.06; 95% CI, 1.3-3.28 for BMI 20-30 kg/m2) dialysis (OR = 0.27; 95% CI, 0.2-0.36) and congestive HF (OR = 0.53; 95% CI, 0.4-0.7) for the peripheral vascular intervention group.
The researchers calculated C-statistics ranging from 0.65 to 0.72 for the primary outcomes.
“The current model, although not fully predictive of outcome, might help provide more information to practitioners and help direct the decision-making process with the use of patient-specific data,” the researchers concluded. They called for additional prospective evaluation of the model in future study. “When validated, the actual usefulness of the model could then be studied prospectively, including the effect on patient outcomes such as patency, limb salvage and quality of life.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.