JMIR Publications

ABSTRACT

Background:

Two-year longevity (2YL) is a crucial consideration in revascularization strategies for patients with symptomatic lower-extremity artery disease (LEAD). However, factors associated with 2YL and risk stratification in octogenarians or nonagenarians have been underreported

Objective:

We aimed to investigate the association variables and stratify the 2-year prognosis in elderly patients with LEAD

Methods:

We performed logistic regression and association rules mining based on the Apriori algorithm to discover the independent variables and validate their associations with 2YL. The malnutrition, inflammation, and stroke (MIS) factors were identified. C-statistics and Kaplan-Meier analysis were used to assess the impact on 2YL of different numbers of MIS factors.

Results:

We recruited a total of 232 octogenarians or nonagenarians (mean age 85±4.2 years) treated with endovascular therapy. During the study period, 81 patients died (33% with a cardiac origin) within 2 years. Association rules analysis showed the interrelationships of neutrophil-lymphocyte ratio (NLR) and nutritional status, determined by the Controlling Nutritional Status (CONUT) score or Geriatric Nutritional Risk Index (GNRI), with 2YL. The cutoff value of NLR, GNRI, and CONUT was ≥3.89, ≤90.3, and >3, respectively. The C-statistics for the predictive power for 2YL were similar between the CONUT score and GNRI-based models (0.773 vs. 0.760, P=0.572). The 2YL was much worse in patients with all three MIS factors than in those without (hazard ratio 18.2 and 13.6 [P<0.001] in the GNRI and CONUT score models, respectively).

Conclusions:

This study demonstrated the association and crucial role of MIS factors in assessing 2YL in elderly patients with LEAD. Using this simple risk score might assist clinicians in selecting the appropriate treatment. Clinical Trial: not applicable