Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysis
Abstract Objectives Among changes in demographics, aging is the most relevant cardiovascular risk factor. The prevalence of peripheral artery disease (PAD) is high in elderly patients and is associated with a worse prognosis. Despite optimal treatments, mortality in the high-risk population of octo-...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | BMC Cardiovascular Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12872-021-02177-1 |
| _version_ | 1819152129649016832 |
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| author | Christos Rammos Aristotelis Kontogiannis Amir A. Mahabadi Martin Steinmetz Daniel Messiha Julia Lortz Tienush Rassaf |
| author_facet | Christos Rammos Aristotelis Kontogiannis Amir A. Mahabadi Martin Steinmetz Daniel Messiha Julia Lortz Tienush Rassaf |
| author_sort | Christos Rammos |
| collection | DOAJ |
| description | Abstract Objectives Among changes in demographics, aging is the most relevant cardiovascular risk factor. The prevalence of peripheral artery disease (PAD) is high in elderly patients and is associated with a worse prognosis. Despite optimal treatments, mortality in the high-risk population of octo- and nonagenarians with PAD remains excessive, and predictive factors need to be identified. The objective of this study was to investigate predictors of mortality in octo- and nonagenarians with PAD. Methods Cases of treated octo- and nonagenarians, including the clinical characteristics and markers of myocardial injury and heart failure, were studied retrospectively with respect to all-cause mortality. Hazard ratios [HR] were calculated and survival was analyzed by Kaplan-Meyer curves and receiver operating characteristic curved were assessed for troponin-ultra and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and chronic limb-threatening ischemia (CLTI). Results A total of 123 octo- and nonagenarians admitted for PAD were eligible. The troponin level was the major predictor of all-cause mortality (HR: 4.6, 95% confidence interval [CI]: 1.4–15.3), followed by the NT-proBNP level (HR: 3.9, 95% CI 1.8–8.8) and CLTI (HR: 3.1, 95% CI 1.6–5.9). Multivariate regression revealed that each increment of 1 standard deviation in log troponin and log NT-proBNP was associated with a 2.7-fold (95% CI 1.8–4.1) and a 1.9-fold (95% CI 1.2–2.9) increased risk of all-cause death. Receiver operating characteristic curve analysis using a combination of all predictors yielded an improved area under the curve of 0.888. In a control group of an equal number of younger individuals, only NT-proBNP (HR: 4.2, 95% CI 1.2–14.1) and CLTI (HR: 6.1, 95% CI 1.6–23.4) were predictive of mortality. Conclusion Our study demonstrates that cardiovascular biomarkers and CLTI are the primary predictors of increased mortality in elderly PAD patients. Further risk stratification through biomarkers in this high-risk population of octo- and nonagenarians with PAD is necessary. |
| first_indexed | 2024-12-22T14:44:23Z |
| format | Article |
| id | doaj.art-09ce9d2699424c68bd9af55c236da886 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-22T14:44:23Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-09ce9d2699424c68bd9af55c236da8862022-12-21T18:22:29ZengBMCBMC Cardiovascular Disorders1471-22612021-08-012111910.1186/s12872-021-02177-1Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysisChristos Rammos0Aristotelis Kontogiannis1Amir A. Mahabadi2Martin Steinmetz3Daniel Messiha4Julia Lortz5Tienush Rassaf6Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-EssenDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-EssenDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-EssenDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-EssenDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-EssenDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-EssenDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-EssenAbstract Objectives Among changes in demographics, aging is the most relevant cardiovascular risk factor. The prevalence of peripheral artery disease (PAD) is high in elderly patients and is associated with a worse prognosis. Despite optimal treatments, mortality in the high-risk population of octo- and nonagenarians with PAD remains excessive, and predictive factors need to be identified. The objective of this study was to investigate predictors of mortality in octo- and nonagenarians with PAD. Methods Cases of treated octo- and nonagenarians, including the clinical characteristics and markers of myocardial injury and heart failure, were studied retrospectively with respect to all-cause mortality. Hazard ratios [HR] were calculated and survival was analyzed by Kaplan-Meyer curves and receiver operating characteristic curved were assessed for troponin-ultra and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and chronic limb-threatening ischemia (CLTI). Results A total of 123 octo- and nonagenarians admitted for PAD were eligible. The troponin level was the major predictor of all-cause mortality (HR: 4.6, 95% confidence interval [CI]: 1.4–15.3), followed by the NT-proBNP level (HR: 3.9, 95% CI 1.8–8.8) and CLTI (HR: 3.1, 95% CI 1.6–5.9). Multivariate regression revealed that each increment of 1 standard deviation in log troponin and log NT-proBNP was associated with a 2.7-fold (95% CI 1.8–4.1) and a 1.9-fold (95% CI 1.2–2.9) increased risk of all-cause death. Receiver operating characteristic curve analysis using a combination of all predictors yielded an improved area under the curve of 0.888. In a control group of an equal number of younger individuals, only NT-proBNP (HR: 4.2, 95% CI 1.2–14.1) and CLTI (HR: 6.1, 95% CI 1.6–23.4) were predictive of mortality. Conclusion Our study demonstrates that cardiovascular biomarkers and CLTI are the primary predictors of increased mortality in elderly PAD patients. Further risk stratification through biomarkers in this high-risk population of octo- and nonagenarians with PAD is necessary.https://doi.org/10.1186/s12872-021-02177-1AgingPeripheral interventionsEndovascular treatmentMortality |
| spellingShingle | Christos Rammos Aristotelis Kontogiannis Amir A. Mahabadi Martin Steinmetz Daniel Messiha Julia Lortz Tienush Rassaf Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysis BMC Cardiovascular Disorders Aging Peripheral interventions Endovascular treatment Mortality |
| title | Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysis |
| title_full | Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysis |
| title_fullStr | Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysis |
| title_full_unstemmed | Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysis |
| title_short | Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysis |
| title_sort | risk stratification and mortality prediction in octo and nonagenarians with peripheral artery disease a retrospective analysis |
| topic | Aging Peripheral interventions Endovascular treatment Mortality |
| url | https://doi.org/10.1186/s12872-021-02177-1 |
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