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Risk Stratification for 2-Year Mortality in Patients with Chronic Limb-Threatening Ischemia Undergoing Endovascular

Yosuke Hata1, Osamu Iida1, Mitsutoshi Asai1

  • 1Kansai Rosai Hospital Cardiovascular Center.

Journal of Atherosclerosis and Thrombosis
|July 28, 2020
PubMed

Insights

The Wound, Ischemia and foot Infection (WIfI) classification predicts 2-year mortality risk in chronic limb-threatening ischemia (CLTI) patients undergoing endovascular therapy. This tool aids in planning revascularization strategies for CLTI.

Area of Science:

  • Vascular Surgery
  • Cardiovascular Medicine
  • Health Outcomes Research

Background:

  • Global Vascular Guidelines (GVG) emphasize 2-year mortality risk assessment for chronic limb-threatening ischemia (CLTI) patients before revascularization.
  • The Wound, Ischemia and foot Infection (WIfI) classification was developed for limb prognosis but its utility in predicting mortality risk is under investigation.

Purpose of the Study:

  • To evaluate the Wound, Ischemia and foot Infection (WIfI) classification's effectiveness in predicting 2-year mortality risk in CLTI patients.
  • To compare the predictive value of WIfI classification against Rutherford classification for mortality in CLTI patients.

Main Methods:

  • Retrospective analysis of 849 CLTI patients treated with endovascular therapy (EVT) from April 2010 to December 2016.
  • Cox proportional hazards regression model used to assess the impact of baseline characteristics, including WIfI classification, on mortality risk.

Main Results:

  • A 2-year mortality rate of 32.3% was observed in the cohort.
  • Multivariate analysis identified WIfI classification stages as an independent predictor of mortality (p=0.037).
  • Other independent predictors included male sex, age, non-ambulatory status, BMI, and hemodialysis; Rutherford classification was not significant.

Conclusions:

  • WIfI classification stages are independently associated with 2-year mortality risk in CLTI patients undergoing EVT.
  • WIfI classification serves as a practical tool for revascularization strategy planning in CLTI management.
  • Rutherford classification did not show significant association with mortality risk in this cohort.
Abstract

Keywords:
Chronic limb-threatening ischemiaEndovascular therapyMortalityRisk stratificationWIfI classification

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