Factors associated with all-cause mortality in endovascularly treated patients with chronic limb-threatening ischemia

TL;DR

This study finds that female sex, treatment in multiple regions, and high creatinine and fibrinogen levels are linked to higher 5-year mortality in patients treated for chronic limb-threatening ischemia.

Contribution

The study identifies novel associations between clinical factors and mortality in endovascularly treated CLTI patients.

Findings

Female sex is associated with a 42% higher mortality risk after 5 years.

Treating two or more anatomical regions increases mortality risk by 37%.

Higher creatinine and fibrinogen levels are strongly linked to increased mortality.

Abstract

Despite advances in treatment, mortality in patients with chronic limb-threatening ischemia (CLTI) is high. The aim of our study was to evaluate 5-year all-cause mortality and factors associated with it in endovascularly treated (EVT) patients with foot ischemic ulcers.

We reviewed all patients who had undergone EVT for lower extremity peripheral artery disease between January 2016 and December 2018. Adjustments in multivariate analyses were performed for age, hypertension, diabetes mellitus, sex, smoking, dyslipidemia, chronic obstructive pulmonary disease, malignancy, atrial fibrillation, heart failure with reduced ejection fraction, coronary artery disease, postprocedural ipsilateral amputation, ipsilateral reintervention, number of endovascularly treated regions, fibrinogen and creatinine.

Four hundred and fifty-one patients (155 women, 296 men) with a mean age of 70.4 ± 9.60 years were included in the analysis. The 5-year all-cause mortality was 60.5%. In multivariate analysis mortality risk was higher in women (HR 1.42; 95% CI 1.09–1.86; p = 0.010), and after EVT in two or more anatomical regions (HR 1.37; 95% CI 1.05–1.79; p = 0.022). The mortality risk was positively associated with creatinine (HR 1.003; 95% CI 1.002–1.004; p < 0.001), and fibrinogen (HR 1.19; 95% CI 1.11–1.29; p < 0.001). Ipsilateral reintervention (HR 0.67; 95%CI 0.47–0.94; p = 0.021) and ipsilateral amputation after EVT (HR 0.71; 95% CI 0.51–0.98; p = 0.037) were associated with lower all-cause mortality risk.

Female sex, treatment in two or more anatomical regions, creatinine and fibrinogen were associated with higher 5-year mortality risk. Lower 5-year all-cause mortality risk was observed in patients with ipsilateral reintervention and ipsilateral amputation after EVT.

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