PT Unknown
AU Rammos, C
   Kontogiannis, A
   Mahabadi, A
   Steinmetz, M
   Messiha, D
   Lortz, J
   Rassaf, T
TI Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysis
PD 08
PY 2021
DI 10.1186/s12872-021-02177-1
LA en
DE Aging; Peripheral interventions; Endovascular treatment; Mortality
AB 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.
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