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Risk Models and Scores in Patients with Peripheral Artery Disease and Chronic Limb-threatening Ischemia: A
Damianos G Kokkinidis1, Adarsh Katamreddy1, Stefanos Giannopoulos2
1Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
Insights
Risk models and scores aid personalized medicine for peripheral artery disease (PAD) and chronic limb-threatening ischemia (CLTI). This review evaluates validated scores for screening, functional assessment, amputation risk, revascularization, and outcomes in PAD patients.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Medical Informatics
Background:
- Peripheral artery disease (PAD) impacts over 200 million globally.
- Chronic limb-threatening ischemia (CLTI), the advanced stage of PAD, has high morbidity and mortality.
- Personalized medicine is a growing trend in cardiovascular care, requiring individualized risk assessment.
Purpose of the Study:
- To provide a comprehensive overview of selected risk models and scores for patients with PAD and CLTI.
- To categorize available scoring systems based on their clinical utility.
- To highlight limitations and future directions for risk stratification in PAD and CLTI.
Main Methods:
- Review of existing literature on risk models and scores for PAD and CLTI.
- Inclusion of externally validated scores or those with promising initial findings.
- Categorization of scores into five utility groups: screening, functional assessment, amputation risk, revascularization strategy, and outcome prediction.
Main Results:
- Scores were grouped by utility: PAD screening, functional status/quality of life, CLTI amputation risk, revascularization strategy/success, and procedural/long-term outcomes.
- Identified limitations include population specificity, lack of external validation for some scores, and outdatedness concerning endovascular technology.
Conclusions:
- Current risk models and scores offer valuable tools for managing PAD and CLTI.
- Further optimization and development of scoring systems are necessary to fully implement personalized medicine in vascular care.
- Enhanced risk stratification can improve patient outcomes and guide treatment decisions in PAD and CLTI.
Abstract:
Peripheral artery disease (PAD) affects more than 200 million patients worldwide and chronic limbthreatening ischemia (CLTI) is the most advanced stage of PAD with very high morbidity and mortality rates. Cardiovascular medicine is trending towards a more personalized approach where each individual patient will be managed according to specific risk factors, disease characteristics, expectations related to their disease and individualized assessment of potential outcomes. For this reason, a number of risk models and scores have been developed during the last few years. Our aim in this comprehensive review article is to provide an overview of selected risk models and scores for patients with PAD and CLTI. Given that some of the published scores were of low quality (minimal discriminatory ability), we included scores that were already externally validated or scores that had promising initial findings. Available scoring systems were grouped in the five following categories according to their utility: i) scores that can detect asymptomatic patients who should be screened for PAD, ii) scores for assessment of functional status and quality of life in patients with PAD, iii) scores assessing risk for amputation and other major adverse limb events among patients with CLTI, iv) scores for the optimal revascularization strategy in each patient and scores predicting successful procedural outcomes; v) scores predicting short or long-term cardiovascular and limb related outcomes after either revascularization or at least angiographic assessment. Limitations of available scoring systems include development and validation in specific populations, lack of external validation (for some of them) and also lack of synchrony with current era endovascular technology. However, with further optimization of current scores and the development of new scores, the field of PAD and CLI can be transitioned to a personalized medicine approach.
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