Revascularization for Poor-Risk Critical Limb Ischemia

Study Questions:

What is the prognostic impact of revascularization for poor-risk critical limb ischemia (CLI) patients in real-world settings?

Methods:

The investigators conducted a multicenter prospective observational study, registering patients who presented with CLI and who required assistance for their daily lives because of their disability in activities of daily living (ADL) and/or impairment of cognitive function. Revascularization was either planned (revascularization group) or not planned (non-revascularization group). The primary endpoint was 1-year survival, and was compared between the revascularization and non-revascularization groups, using the propensity score-matching method.

Results:

Between January 2014 and April 2015, a total of 662 patients were registered; of those 100 non-revascularization patients were included. A total of 625 patients (94.4%) completed the 1-year follow-up. Death was observed in 223 patients (33.7%). After propensity score matching, the 1-year survival rate was 55.9% in the revascularization group versus 51.0% in the non-revascularization group, with no significant difference (p = 0.120). In the subgroups alive at 1 year after revascularization, health-related quality of life was significantly improved compared with baseline, whereas ADL scores were unchanged from baseline and still remained significantly worse than before CLI onset.

Conclusions:

The authors concluded that the 1-year overall survival rate was not significantly different between the revascularization and non-revascularization groups in poor-risk CLI patients.

Perspective:

This study reports that there were no significant differences in 1-year survival between the revascularization and non-revascularization groups for poor-risk CLI patients in real-world settings. One favorable finding for revascularization in the current study was a significant improvement of quality-of-life scores in patients alive for 1 year after revascularization. Additional studies are indicated to determine whether a rehabilitation program may prevent a decline in ADL and cognitive function during hospitalization, and could maximize clinical advantages of revascularization for CLI.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias

Keywords: Activities of Daily Living, Cognition, Ischemia, Quality of Life, Myocardial Revascularization, Risk, Secondary Prevention, Survival Rate, Vascular Diseases


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