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Frailty influences amputation-free survival in patients with CLI
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In patients with critical limb ischemia who have undergone endovascular or surgical revascularization, a frailty index was a risk factor for amputation-free survival at 2 years, according to new findings.
Researchers conducted a retrospective study of 266 patients who underwent endovascular or surgical infrapopliteal revascularization of 325 limbs between 2007 and 2015.
Patients were defined as CLI frail if they had two or more of the following: low Geriatric Nutritional Risk Index, low skeletal muscle mass index or nonambulatory status.
The researchers also compared the CLI Frailty Index with a modified Frailty Index.
The primary outcome was amputation-free survival at 2 years.
An endovascular-first strategy was used in 79.6% of CLI frail patients and 71.4% of those who were not CLI frail (P = .14).
At 1 year, the amputation-free survival rate was 45.8% for those who were CLI frail and 81.8% for those who were not, and at 2 years, it was 34% for those who were CLI frail and 72.9% for those who were not (P < .001), Koichi Morisaki, MD, PhD, from the department of vascular surgery at Matsuyama Red Cross Hospital in Ehime, Japan, and colleagues wrote.
The researchers determined that the CLI Frailty Index was an independent predictor of 2-year amputation-free survival (HR = 2.77; 95% CI, 1.78-4.32), as was hemodialysis (HR = 1.72; 95% CI, 1.11-2.69).
The area under the curve for the CLI Frailty Index was 0.72 vs. 0.63 for the modified Frailty Index (P = .01).
The CLI Frailty Index was the only independent predictor of morbidity, defined as Clavin-Dindo class IV complications (HR = 3.21; 95% CI, 1.45-7.27) and 30-day or in-hospital mortality (HR = 6.32; 95% CI, 1.43-43.7), according to the researchers.
“These results should be useful for decision-making in selecting either bypass surgery or [endovascular therapy] as the first treatment strategy,” Morisaki and colleagues wrote. “The BASIL trial in 2005 showed that surgical revascularization was recommended for CLI patients who were likely to survive > 2 years after revascularization. We recommend bypass as a first treatment strategy for nonfrail patients diagnosed according to the CLI Frailty Index.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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