Revascularization for Poor-Risk Critical Limb Ischemia
What is the prognostic impact of revascularization for poor-risk critical limb ischemia (CLI) patients in real-world settings?
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.
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.
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.
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.
Keywords: Activities of Daily Living, Cognition, Ischemia, Quality of Life, Myocardial Revascularization, Risk, Secondary Prevention, Survival Rate, Vascular Diseases
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