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Association between High Bleeding Risk and 2-Year Mortality in Patients with Chronic Limb-Threatening Ischemia

Naoki Yoshioka1, Takahiro Tokuda2, Akio Koyama3

  • 1Department of Cardiology, Ogaki Municipal Hospital.

Journal of Atherosclerosis and Thrombosis
|March 22, 2023
PubMed

Insights

High bleeding risk (HBR) in chronic limb-threatening ischemia (CLTI) patients significantly predicts 2-year mortality. The Academic Research Consortium for HBR (ARC-HBR) score helps guide treatment decisions for better patient outcomes.

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Geriatric Medicine

Background:

  • Chronic limb-threatening ischemia (CLTI) presents a significant clinical challenge with high mortality rates.
  • Patients with CLTI often have a high bleeding risk (HBR), complicating treatment strategies.
  • Accurate prognostication is crucial for tailoring interventions to individual patient profiles.

Purpose of the Study:

  • To evaluate the prognostic impact of HBR on 2-year mortality in CLTI patients.
  • To assess the utility of the Academic Research Consortium for HBR (ARC-HBR) score in predicting outcomes.
  • To determine the relationship between ARC-HBR scores and major bleeding events.

Main Methods:

  • A cohort of 259 CLTI patients undergoing endovascular therapy (EVT) was analyzed.
  • The Academic Research Consortium for HBR (ARC-HBR) criteria were used to calculate HBR scores.
  • A Classification and Regression Tree (CART) model identified a cut-off score for 2-year all-cause mortality prediction.

Main Results:

  • Patients were stratified into low (0-1.0), moderate (1.5-3.0), and high (≥3.5) ARC-HBR score groups.
  • All-cause mortality (39.6%) and major bleeding events increased significantly with higher ARC-HBR scores.
  • High ARC-HBR scores were independently associated with increased 2-year all-cause mortality.

Conclusions:

  • The ARC-HBR score effectively predicts 2-year mortality in CLTI patients treated with EVT.
  • This score aids in selecting optimal revascularization strategies for CLTI patients.
  • Integrating HBR assessment into clinical practice can improve patient management and outcomes.
Abstract

Keywords:
Chronic limb-threatening ischemiaEndovascular therapyHigh bleeding riskLower extremity artery diseaseMortality

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