PMID- 38334045
OWN - NLM
STAT- MEDLINE
DCOM- 20240412
LR  - 20240429
IS  - 1477-0377 (Electronic)
IS  - 1358-863X (Linking)
VI  - 29
IP  - 2
DP  - 2024 Apr
TI  - Evaluation of short-term mortality in patients with Medicare undergoing 
      endovascular interventions for chronic limb-threatening ischemia.
PG  - 172-181
LID - 10.1177/1358863X231224335 [doi]
AB  - INTRODUCTION: Patients with chronic limb-threatening ischemia (CLTI) have high 
      mortality rates after revascularization. Risk stratification for short-term 
      outcomes is challenging. We aimed to develop machine-learning models to rank 
      predictive variables for 30-day and 90-day all-cause mortality after peripheral 
      vascular intervention (PVI). METHODS: Patients undergoing PVI for CLTI in the 
      Medicare-linked Vascular Quality Initiative were included. Sixty-six 
      preprocedural variables were included. Random survival forest (RSF) models were 
      constructed for 30-day and 90-day all-cause mortality in the training sample and 
      evaluated in the testing sample. Predictive variables were ranked based on the 
      frequency that they caused branch splitting nearest the root node by 
      importance-weighted relative importance plots. Model performance was assessed by 
      the Brier score, continuous ranked probability score, out-of-bag error rate, and 
      Harrell's C-index. RESULTS: A total of 10,114 patients were included. The crude 
      mortality rate was 4.4% at 30 days and 10.6% at 90 days. RSF models commonly 
      identified stage 5 chronic kidney disease (CKD), dementia, congestive heart 
      failure (CHF), age, urgent procedures, and need for assisted care as the most 
      predictive variables. For both models, eight of the top 10 variables were either 
      medical comorbidities or functional status variables. Models showed good 
      discrimination (C-statistic 0.72 and 0.73) and calibration (Brier score 0.03 and 
      0.10). CONCLUSION: RSF models for 30-day and 90-day all-cause mortality commonly 
      identified CKD, dementia, CHF, need for assisted care at home, urgent procedures, 
      and age as the most predictive variables as critical factors in CLTI. Results may 
      help guide individualized risk-benefit treatment conversations regarding PVI.
FAU - Cleman, Jacob
AU  - Cleman J
AUID- ORCID: 0000-0002-6143-0237
AD  - Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Yale 
      University, New Haven, CT, USA.
FAU - Romain, Gaelle
AU  - Romain G
AD  - Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Yale 
      University, New Haven, CT, USA.
FAU - Callegari, Santiago
AU  - Callegari S
AD  - Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Yale 
      University, New Haven, CT, USA.
FAU - Scierka, Lindsey
AU  - Scierka L
AD  - Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Yale 
      University, New Haven, CT, USA.
FAU - Jacque, Francky
AU  - Jacque F
AD  - Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Yale 
      University, New Haven, CT, USA.
FAU - Smolderen, Kim G
AU  - Smolderen KG
AUID- ORCID: 0000-0001-6104-6254
AD  - Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Yale 
      University, New Haven, CT, USA.
AD  - Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
FAU - Mena-Hurtado, Carlos
AU  - Mena-Hurtado C
AUID- ORCID: 0000-0002-4954-5672
AD  - Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Yale 
      University, New Haven, CT, USA.
LA  - eng
PT  - Journal Article
DEP - 20240209
PL  - England
TA  - Vasc Med
JT  - Vascular medicine (London, England)
JID - 9610930
SB  - IM
MH  - Humans
MH  - Aged
MH  - United States/epidemiology
MH  - Chronic Limb-Threatening Ischemia
MH  - Risk Factors
MH  - Treatment Outcome
MH  - *Peripheral Arterial Disease/diagnostic imaging/surgery
MH  - *Endovascular Procedures/methods
MH  - Ischemia/diagnostic imaging/surgery
MH  - Limb Salvage/methods
MH  - Medicare
MH  - *Kidney Failure, Chronic/complications
MH  - *Dementia/complications
MH  - Retrospective Studies
MH  - Chronic Disease
OTO - NOTNLM
OT  - chronic limb-threatening ischemia (CLTI)
OT  - outcomes
OT  - peripheral artery disease (PAD)
OT  - peripheral vascular intervention
OT  - risk prediction
COIS- Declaration of conflicting interestsThe authors declared the following potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article: Dr Mena-Hurtado reports unrestricted research grants 
      from Philips and Shockwave, and is a consultant for Abbott Vascular, Cook, 
      Medtronic, and Optum Labs; Dr Smolderen reports unrestricted research grants from 
      Philips, Merck, Shockwave, and Johnson & Johnson; she is a consultant for Optum 
      Labs, Cook, Tegus, Twill Inc., and Abbott Vascular. The other authors report no 
      competing interests.
EDAT- 2024/02/09 06:42
MHDA- 2024/04/12 06:45
CRDT- 2024/02/09 05:52
PHST- 2024/04/12 06:45 [medline]
PHST- 2024/02/09 06:42 [pubmed]
PHST- 2024/02/09 05:52 [entrez]
AID - 10.1177/1358863X231224335 [doi]
PST - ppublish
SO  - Vasc Med. 2024 Apr;29(2):172-181. doi: 10.1177/1358863X231224335. Epub 2024 Feb 
      9.