Analysis of in-hospital deaths in patients with critical limb ischemia necessitating invasive treatments: based on a Japanese nationwide database.

IF 3.1 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Intervention and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-04-30 DOI:10.1007/s12928-024-01003-7
Kiwamu Iwata, Manabu Nitta, Makoto Kaneko, Kiyohide Fushimi, Shinichiro Ueda, Sayuri Shimizu
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Abstract

Critical limb ischemia (CLI) is associated with systemic cardiovascular and non-cardiovascular diseases. Treatments primarily targeting limb-related outcomes may not improve overall life prognosis. We aimed to describe in-hospital mortality and the underlying etiologies in Japanese patients with CLI. We analyzed the Diagnosis Procedure Combination (DPC) database from approximately 1200 Japanese acute-care hospitals between April 2018 and March 2020. The definition of patients with CLI was based on the diagnostic codes listed as the most resource-intensive diagnosis and information regarding invasive procedures (endovascular treatment, bypass, or amputation). The DPC database provides information on whether in-hospital death was caused by the most resource-intensive diagnosis. Among 15,228 distinct patients with CLI, we identified 18,970 records, including 5,378 amputations. In-hospital death occurred in 1238 (6.5%) patients. Among them, 811 (65.5%) were due to causes unrelated to CLI. In patients who underwent amputation (n = 5378), causes unrelated to CLI accounted for 70.0% of in-hospital deaths, whereas among patients who did not undergo amputation (n = 13,592), this proportion was 60.1%. When compared to patients who died due to causes related to CLI, the prevalence of male patients was higher (62.6% vs 52.7%, p = 0.001), and amputation was more frequently performed (58.0% vs 47.1%, p < 0.001) in those who died due to causes unrelated to CLI. The majority of in-hospital deaths among patients with CLI necessitating endovascular treatment, bypass, or amputation were attributable to factors unrelated to the primary condition of CLI. Managing systemic cardiovascular and non-cardiovascular diseases beyond the affected limb is crucial to improve the prognosis of these patients.

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需要进行侵入性治疗的危重肢体缺血患者院内死亡分析:基于日本全国数据库。
严重肢体缺血(CLI)与全身性心血管和非心血管疾病有关。主要针对肢体相关结果的治疗可能无法改善整体预后。我们旨在描述日本 CLI 患者的院内死亡率和潜在病因。我们分析了 2018 年 4 月至 2020 年 3 月期间约 1200 家日本急诊医院的诊断程序组合(DPC)数据库。CLI患者的定义基于被列为最耗费资源的诊断代码和有创手术(血管内治疗、搭桥或截肢)相关信息。DPC 数据库提供了资源密集度最高的诊断是否导致院内死亡的信息。在15228名不同的CLI患者中,我们发现了18970份记录,其中包括5378例截肢。1238例(6.5%)患者在院内死亡。其中,811 人(65.5%)的死亡原因与 CLI 无关。在接受截肢手术的患者(人数=5378)中,与CLI无关的原因占院内死亡的70.0%,而在未接受截肢手术的患者(人数=13592)中,这一比例为60.1%。与因CLI相关原因死亡的患者相比,男性患者的比例更高(62.6% vs 52.7%,p = 0.001),截肢手术的频率更高(58.0% vs 47.1%,p = 0.001)。
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来源期刊
Cardiovascular Intervention and Therapeutics
Cardiovascular Intervention and Therapeutics CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
6.30
自引率
12.50%
发文量
68
期刊介绍: Cardiovascular Intervention and Therapeutics (CVIT) is an international journal covering the field of cardiovascular disease and includes cardiac (coronary and noncoronary) and peripheral interventions and therapeutics. Articles are subject to peer review and complete editorial evaluation prior to any decision regarding acceptability. CVIT is an official journal of The Japanese Association of Cardiovascular Intervention and Therapeutics.
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