Validation of the PIII CLI risk score for the prediction of amputation-free survival in patients undergoing infrainguinal autogenous vein bypass for critical limb ischemia
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Authors
Schanzer, AndresGoodney, Philip P.
Li, YouFu
Eslami, Mohammad H.
Cronenwett, Jack L.
Messina, Louis M.
Conte, Michael S.
UMass Chan Affiliations
Department of SurgeryDocument Type
Journal ArticlePublication Date
2009-07-25Keywords
AgedAged, 80 and over
Amputation
Critical Illness
Double-Blind Method
Female
Follow-Up Studies
Graft Occlusion, Vascular
Graft Survival
Humans
Inguinal Canal
Ischemia
Kaplan-Meier Estimate
Leg
Limb Salvage
Male
Middle Aged
Peripheral Vascular Diseases
Postoperative Complications
Predictive Value of Tests
Probability
Prospective Studies
Risk Assessment
Statistics, Nonparametric
Survival Rate
Time Factors
Transplantation, Autologous
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Patency
Vascular Surgical Procedures
Surgery
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Show full item recordAbstract
OBJECTIVE: The PREVENT III (PIII) critical limb ischemia (CLI) risk score is a simple, published tool derived from the PIII randomized clinical trial that can be used for estimating amputation-free survival (AFS) in CLI patients considered for infrainguinal bypass (IB). The current study sought to validate this risk stratification model using data from the prospectively collected Vascular Study Group of Northern New England (VSGNNE). METHOD: We calculated the PIII CLI risk score for 1166 patients undergoing IB with autogenous vein by 59 surgeons at 11 hospitals between January 1, 2003, and December 31, 2007. Points (pts) were assigned to each patient for the presence of dialysis (4 pts), tissue loss (3 pts), age >or=75 (2 pts), and coronary artery disease (CAD) (1 pt). Baseline hematocrit was not included due to a large proportion of missing values. Total scores were used to stratify each patient into low-risk (or=8 pts) categories. The Kaplan-Meier method was used to calculate AFS for the three risk groups. Log-rank test was used for intergroup comparisons. To assess validation, comparison to the PIII derivation and validation sets was performed. RESULT: Stratification of the VSGNNE patients by risk category yielded three significantly different estimates for 1-year AFS (86.4%, 74.0%, and 56.1%, for low-, med-, and high-risk groups). Intergroup comparison demonstrated precise discrimination (P < .0001). For a given risk category (low, med, or high), the 1-year AFS estimates in the VSGNNE dataset were consistent with those observed in the previously published PIII derivation set (85.9%, 73.0%, and 44.6%, respectively), PIII validation set (87.7%, 63.7%, and 45.0%, respectively), and retrospective multicenter validation set (86.3%, 70.1%, and 47.8%, respectively). CONCLUSION: The PIII CLI risk score has now been both internally and externally validated by testing it against the outcomes of 3286 CLI patients who underwent autogenous vein bypass at 94 institutions by a diverse array of physicians (three independent cohorts of patients). This tool provides a simple and reliable method to risk stratify CLI patients being considered for IB. At initial consultation, calculation of the PIII CLI risk score can reliably stratify patients according to their risk of death or major amputation at 1 year.Source
J Vasc Surg. 2009 Oct;50(4):769-75; discussion 775. Epub 2009 Jul 22. Link to article on publisher's siteDOI
10.1016/j.jvs.2009.05.055Permanent Link to this Item
http://hdl.handle.net/20.500.14038/49682PubMed ID
19628361Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.jvs.2009.05.055