Prediction Models for Two Year Overall Survival and Amputation Free Survival After Revascularisation for Chronic Limb Threatening Ischaemia

Tetsuro Miyata; Hiraku Kumamaru; Shinsuke Mii; Naoko Kinukawa; Hiroaki Miyata; Kunihiro Shigematsu; Nobuyoshi Azuma; Atsuhisa Ishida; Yuichi Izumi; Yoshinori Inoue; Hisashi Uchida; Takao Ohki; Sosei Kuma; Koji Kurosawa; Akio Kodama; Hiroyoshi Komai; Kimihiro Komori; Takashi Shibuya; Shunya Shindo; Ikuo Sugimoto; Juno Deguchi; Katsuyuki Hoshina; Maeda Hideaki; Hirofumi Midorikawa; Terutoshi Yamaoka; Hiroya Yamashita; Yasuhiro Yunoki

doi:10.1016/j.ejvs.2022.05.038

Prediction Models for Two Year Overall Survival and Amputation Free Survival After Revascularisation for Chronic Limb Threatening Ischaemia

Eur J Vasc Endovasc Surg. 2022 Oct;64(4):367-376. doi: 10.1016/j.ejvs.2022.05.038. Epub 2022 Jun 7.

Authors

Tetsuro Miyata¹, Hiraku Kumamaru², Shinsuke Mii³, Naoko Kinukawa², Hiroaki Miyata², Kunihiro Shigematsu⁴, Nobuyoshi Azuma⁵, Atsuhisa Ishida⁶, Yuichi Izumi⁷, Yoshinori Inoue⁸, Hisashi Uchida⁹, Takao Ohki¹⁰, Sosei Kuma¹¹, Koji Kurosawa¹², Akio Kodama¹³, Hiroyoshi Komai¹⁴, Kimihiro Komori¹³, Takashi Shibuya¹⁵, Shunya Shindo¹⁶, Ikuo Sugimoto¹⁷, Juno Deguchi¹⁸, Katsuyuki Hoshina¹⁹, Maeda Hideaki²⁰, Hirofumi Midorikawa²¹, Terutoshi Yamaoka²², Hiroya Yamashita²³, Yasuhiro Yunoki²⁴

Affiliations

¹ Office of Medical Education, School of Medicine, International University of Health and Welfare, Chiba, Japan. Electronic address: [email protected].
² Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Vascular Surgery, Saiseikai Yahata General Hospital, Fukuoka, Japan.
⁴ Department of Vascular Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
⁵ Department of Vascular Surgery, Asahikawa Medical University Hospital, Hokkaido, Japan.
⁶ Department of Surgery, Kawasaki Medical School General Medical Centre, Okayama, Japan.
⁷ Department of Cardiovascular Surgery, Nayoro City General Hospital, Hokkaido, Japan.
⁸ Ambulatory Vascular Surgical Clinic Tokyo, Tokyo, Japan.
⁹ Department of Cardiovascular Surgery, Sapporo Kousei Hospital, Hokkaido, Japan.
¹⁰ Department of Vascular Surgery, The Jikei University Hospital, Tokyo, Japan.
¹¹ Department of Vascular Surgery, Kyushu Central Hospital, Fukuoka, Japan.
¹² Department of Vascular Surgery, Atsugi City Hospital, Kanagawa, Japan.
¹³ Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan.
¹⁴ Department of Vascular Surgery, Kansai Medical University Medical Centre, Osaka, Japan.
¹⁵ Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan.
¹⁶ Department of Cardiovascular Surgery, Tokyo Medical University, Hachioji Medical Centre, Tokyo, Japan.
¹⁷ Department of Medical Safety Management, Aichi Medical University, Aichi, Japan.
¹⁸ Department of Vascular Surgery, Saitama Medical Centre, Saitama Medical University, Saitama, Japan.
¹⁹ Department of Vascular Surgery, The University of Tokyo Hospital, Tokyo, Japan.
²⁰ Department of Vascular Surgery, Nihon University Itabashi Hospital, Tokyo, Japan.
²¹ Department of Cardiovascular Surgery, Southern TOHOKU General Hospital, Fukushima, Japan.
²² Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.
²³ Department of Vascular Surgery, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
²⁴ Department of Cardiovascular Surgery, Kawasaki Medical School Hospital, Okayama, Japan.

PMID: 35680042
DOI: 10.1016/j.ejvs.2022.05.038

Abstract

Objective: The aim of this study was to create prediction models for two year overall survival (OS) and amputation free survival (AFS) after revascularisation in patients with chronic limb threatening ischaemia (CLTI).

Methods: This was a retrospective analysis of prospectively collected multicentre registry data (JAPAN Critical Limb Ischaemia Database; JCLIMB). Data from 3 505 unique patients with CLTI who had undergone revascularisation from 2013 to 2017 were extracted from the JCLIMB for the analysis. The cohort was randomly divided into development (2 861 patients) and validation cohorts (644 patients). In the development cohort, multivariable risk models were constructed to predict two year OS and AFS using Cox proportional hazard regression analysis. These models were applied to the validation cohort and their performances were evaluated using Harrell's C index and calibration plots.

Results: Kaplan-Meier estimates of two year OS and AFS post-revascularisation in the whole cohort were 69% and 62%, respectively. Strong predictors for OS consisted of age, activity, malignant neoplasm, chronic kidney disease (CKD), congestive heart failure (CHF), geriatric nutritional risk index (GNRI), and sex. Strong predictors for AFS included age, activity, malignant neoplasm, CKD, CHF, GNRI, body temperature, white blood cells, urgent revascularisation procedure, and sex. Prediction models for two year OS and AFS showed good discrimination with Harrell's C indexes of 0.73 (95% confidence interval [CI] 0.69 - 0.77) and 0.72 (95% CI 0.68 - 0.76), respectively CONCLUSION: Prediction models for two year OS and AFS post-revascularisation in patients with CLTI were created. They can assist in determining treatment strategies and serve as risk adjustment modalities for quality benchmarking for revascularisation in patients with CLTI at each facility.

Keywords: Amputation free survival; Chronic limb threatening ischaemia; Overall survival; Risk prediction model.

MeSH terms

Aged
Chronic Disease
Chronic Limb-Threatening Ischemia
Humans
Ischemia / diagnosis
Ischemia / surgery
Limb Salvage / methods
Peripheral Arterial Disease* / diagnosis
Peripheral Arterial Disease* / surgery
Renal Insufficiency, Chronic* / diagnosis
Retrospective Studies
Risk Assessment
Risk Factors
Treatment Outcome