This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (5)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cardiovascular System  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Cardiac Diagnostic Tests  • Alert me on articles by topic  Social Bookmarking   What's this?

Harm H. H. Feringa, MD; Jeroen J. Bax, MD; Sanne Hoeks, MSc; Virginie H. van Waning, MD; Abdou Elhendy, MD, PhD; Stefanos Karagiannis, MD; Radosav Vidakovic, MD; Olaf Schouten, MD; Eric Boersma, PhD; Don Poldermans, MD, PhD

Arch Intern Med. 2007;167(22):2482-2489.

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 β-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.

Author Affiliations: Departments of Cardiology (Drs Feringa, Karagiannis, Vidakovic, and Boersma and Ms Hoeks), Anesthesiology (Drs van Waning and Poldermans), and Vascular Surgery (Dr Schouten), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiology (Dr Bax), Leiden University Medical Center, Leiden, the Netherlands; and Department of Cardiology, Marshfield Clinics, Marshfield, Wisconsin (Dr Elhendy).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Association between Protein Levels and Mortality in Patients with Peripheral Arterial Disease
McDermott et al.
ANN INTERN MED 2008;149:64-65.
FULL TEXT