title: Predictive scoring model of mortality after surgical or endovascular revascularization in patients with critical limb ischemia.
abstract: OBJECTIVE
  The latest guideline points to life expectancy of <2 years as the main determinant in revascularization modality selection (bypass surgery [BSX] or endovascular therapy [EVT]) in patients with critical limb ischemia (CLI). This study examined predictors and a predictive scoring model of 2-year mortality after revascularization.
  
  
  METHODS
  We performed Cox proportional hazards regression analysis of data in a retrospective database, the Bypass and Endovascular therapy Against Critical limb ischemia from Hyogo (BEACH) registry, of 459 consecutive CLI patients who underwent revascularization (396 EVT and 63 BSX cases between January 2007 and December 2011) to determine predictors of 2-year mortality. The predictive performance of the score was assessed with the area under the time-dependent receiver operating characteristic curve.
  
  
  RESULTS
  Of 459 CLI patients (mean age, 72 ± 10 years; 64% male; 49% nonambulatory status, 68% diabetes mellitus, 47% on regular dialysis, and 18% rest pain and 82% tissue loss as treatment indication), 84 died within 2 years after revascularization. In a multivariate model, age >75 years (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.10-2.85), nonambulatory status (HR, 5.32; 95% CI, 2.96-9.56), regular dialysis (HR, 1.90; 95% CI, 1.10-3.26), and ejection fraction <50% (HR, 2.49; 95% CI, 1.48-4.20) were independent predictors of 2-year mortality. The area under the time-dependent receiver operating characteristic curve for the developed predictive BEACH score was 0.81 (95% CI, 0.76-0.86).
  
  
  CONCLUSIONS
  Predictors of 2-year mortality after EVT or BSX in CLI patients included age >75 years, nonambulatory status, regular dialysis, and ejection fraction <50%. The BEACH score derived from these predictors allows risk stratification of CLI patients undergoing revascularization.
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Hyogo, Japan. Electronic address: Shiraki.tatsuya@gmail.com.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Shiraki
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Hyogo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.affiliation: Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Takahara
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Hyogo, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Okamoto
authors.affiliation: Department of Surgery, Shinsuma General Hospital, Hyogo, Japan.
authors.forename: Ikurou
authors.initials: I
authors.lastname: Kitano
authors.affiliation: Department of Surgery, Shinsuma General Hospital, Hyogo, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Tsuji
authors.affiliation: Department of Plastic Surgery, Kobe University of Medicine, Hyogo, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Terashi
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Hyogo, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Uematsu
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D016638:Critical Illness; D003661:Decision Support Techniques; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*