title: A prognostic risk index for long-term mortality in patients with peripheral arterial disease.
abstract: BACKGROUND
  Prognostic information in peripheral arterial disease (PAD) may provide the basis for optimal management strategies at an early stage. This study aimed to develop a prognostic risk index for long-term mortality in patients with PAD.
  
  
  METHODS
  In a single-center observational cohort study, 2642 patients with an ankle-brachial index of 0.90 or lower were randomly divided into derivation (n = 1332) and validation (n = 1310) cohorts. Cox regression analysis with stepwise backward elimination identified predictors of 1-year, 5-year, and 10-year mortality in the derivation cohort. Weighted points were assigned to each predictor. Index discrimination was determined in both the derivation and validation cohorts.
  
  
  RESULTS
  During 10 years of follow-up, 42.2% and 40.4% of patients died in the derivation and validation cohorts, respectively. The risk index for 10-year mortality (+ points) included renal dysfunction (+12), heart failure (+7), ST-segment changes (+5), age greater than 65 years (+5), hypercholesterolemia (+5), ankle-brachial index lower than 0.60 (+4), Q-waves (+4), diabetes (+3), cerebrovascular disease (+3), and pulmonary disease (+3). Statins (-6), aspirin (-4), and beta-blockers (-4) were associated with reduced 10-year mortality. Patients were stratified into low (<0 points), low-intermediate (0-5 points), high-intermediate (6-9 points), and high (>9 points) risk categories, according to risk score. Ten-year mortality rates were 22.1%, 32.2%, 45.8%, and 70.4%, respectively (P < .001) and comparable to mortality in the validation cohort. C statistics demonstrated good discrimination in both the derivation (0.72) and validation cohorts (0.73).
  
  
  CONCLUSIONS
  A prognostic risk index for long-term mortality stratified patients with PAD into different risk categories. This may be useful for risk stratification, patient counseling, and medical decision making.
authors: Erasmus Medical Center, Department of Anesthesiology, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
authors: Harm H H
authors: HH
authors: Feringa
authors: Jeroen J
authors: JJ
authors: Bax
authors: Sanne
authors: S
authors: Hoeks
authors: Virginie H
authors: VH
authors: van Waning
authors: Abdou
authors: A
authors: Elhendy
authors: Stefanos
authors: S
authors: Karagiannis
authors: Radosav
authors: R
authors: Vidakovic
authors: Olaf
authors: O
authors: Schouten
authors: Eric
authors: E
authors: Boersma
authors: Don
authors: D
authors: Poldermans
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology