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Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia
Published on: June 8, 2019
Complex relationship of body mass index with mortality in patients with critical limb ischemia undergoing
Insights
Patients with critical limb ischemia (CLI) undergoing endovascular treatment (EVT) who are underweight have a significantly poorer prognosis. Overweight or obese patients with CLI demonstrated better survival rates post-EVT compared to normal weight individuals.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Critical limb ischemia (CLI) poses a significant threat to limb and life.
- Endovascular treatment (EVT) is a primary revascularization strategy for CLI.
- The impact of body mass index (BMI) on long-term outcomes after EVT for CLI remains incompletely understood.
Purpose of the Study:
- To examine the association between BMI categories and long-term survival and limb salvage in patients with CLI.
- To identify prognostic factors influencing outcomes in CLI patients treated with EVT.
Main Methods:
- A retrospective multicenter study analyzed 1088 patients with CLI who underwent EVT for infrapopliteal lesions.
- Patients were stratified into underweight (BMI <18.5 kg/m2), normal weight (18.5-24.9 kg/m2), and overweight/obese (BMI >25.0 kg/m2) groups.
- Primary endpoints included overall survival and freedom from major adverse limb events (MALE).
Main Results:
- Three-year overall survival was significantly lower in underweight (33.3%) and higher in overweight/obese (69.8%) patients compared to normal weight (61.2%) individuals (p < .0001).
- Freedom from MALE did not significantly differ across BMI groups (p = .32).
- Independent predictors of poor survival included low BMI, heart failure, renal failure, and Rutherford 6 classification.
Conclusions:
- BMI exhibits a complex relationship with mortality in CLI patients post-EVT.
- Underweight status is an independent predictor of extremely poor prognosis in this population.
- Overweight/obesity may be associated with improved survival compared to normal weight in CLI patients undergoing EVT.
Objective:
To investigate the relationship between body mass index (BMI) and long-term outcomes of patients with CLI after endovascular treatment (EVT).
Design:
Retrospective multicenter study.
Subjects:
1088 consecutive patients (1306 limbs, mean age 72 ± 10 years) with CLI who underwent EVT for isolated infrapopliteal artery lesions were evaluated. These subjects were identified in the J-BEAT III registry.
Methods:
The patients were divided into groups based on BMI <18.5 kg/m2 (underweight, n = 188; 219 limbs), 18.5 to 24.9 kg/m2 (normal weight, n = 718; 868 limbs), and >25.0 kg/m2 (overweight/obese, n = 182; 219 limbs). The endpoints were overall survival and freedom from major adverse limb events (MALE).
Results:
The median follow up period was 1.5 years (range: 1 month-8.7 years). The 3 year overall survival rates were 33.3%, 61.2%, and 69.8% in underweight, normal, and overweight/obese patients, respectively. The survival rate was significantly lower in underweight patients and significantly higher in overweight/obese patients compared with patients of normal weight (both p < .0001). The 3 year rates of freedom from MALE did not differ significantly among the three groups (36.4%, 45.4%, and 52.3%, respectively, p = .32). Age, BMI <18.5 kg/m2, heart failure, aortic valve stenosis, renal failure, triglyceride levels, serum albumin <3.0 g/dL, anticoagulant treatment, non-ambulatory status, and Rutherford 6 classification all were significantly associated with overall survival.
Conclusions:
BMI has a complex correlation with mortality in patients with CLI after EVT for isolated infrapopliteal artery lesions. Underweight patients with CLI have an extremely poor prognosis. Such patients have many other factors associated with mortality, but low BMI was identified as an independent predictor of a poor prognosis in patients with CLI. Similarly, normal weight patients had a small but significant increase in mortality compared with overweight/obese patients.
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