Utility of the ACD-GENE-CLI Score in Asian Patients with Critical Limb Ischemia Undergoing Endovascular Interventions

  • Chang Wei-Ting
    School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center
  • Huang Po-Sen
    Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center
  • Su Li-Wei
    Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center
  • Liao Chia-Te
    Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center School of Medicine, College of Medicine, National Sun Yat-Sen University Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven
  • Siong Toh Han
    Department of Intensive Care Medicine, Chi Mei Medical Centre Department of Health and Nutrition, Chia Nan University of Pharmacy and Science
  • Chen Yi-Chen
    Department of Medical Research, Chi-Mei Medical Center
  • Ho Chung‑Han
    Department of Medical Research, Chi-Mei Medical Center Department of Information Management, Southern Taiwan University of Science and Technology
  • Chen Zhih-Cherng
    Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center School of Medicine, College of Medicine, National Sun Yat-Sen University
  • Hsu Po-Chao
    Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital Department of Internal Medicine, Faculty of Medicine, School of Medicine, Kaohsiung Medical University
  • Hong Chon-Seng
    Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center Department of Health and Nutrition, Chia Nan University of Pharmacy and Science

抄録

<p> Aims: Critical limb ischemia (CLI) is an emerging public health threat and lacks a reliable score for predicting the outcomes. The Age, Body Mass Index, Chronic Kidney Disease, Diabetes, and Genotyping (ABCD-GENE) risk score helps identify patients with coronary artery disease who have cytochrome P450 2C19 (CYP2C19) polymorphism-related drug resistance and are at risk for cardiovascular adverse events. However, its application to CLI remains unknown. In this study, we aim to validate a modified ACD-GENE-CLI score to improve the prediction of major adverse limb events (MALEs) in patients with CLI receiving clopidogrel.</p><p>Methods: Patients with CLI receiving clopidogrel post-endovascular intervention were enrolled prospectively in two medical centers. Amputation and revascularization as MALEs were regarded as the outcomes.</p><p>Results: A total of 473 patients were recruited, with a mean follow-up duration of 25 months. Except for obesity, old age, diabetes, chronic kidney disease (CKD), and CYP2C19 polymorphisms were significantly associated with MALEs. Using bootstrap regression analysis, we established a modified risk score (ACD-GENE-CLI) that included old age (≥ 65 years), diabetes, CKD, and CYP2C19 polymorphisms. At a cutoff value of 8, the ACD-GENE-CLI score was superior to the CYP2C19 deficiency only, and the conventional ABCD-GENE score in predicting MALEs (area under the curve: 0.69 vs. 0.59 vs. 0.67, p=0.01). The diagnostic ability of the ACD-GENE-CLI score was consistent in the external validation. Also, Kaplan–Meier curves showed that in CYP2C19 deficiency, the ABCD-GENE and ACD-GENE-CLI scores could all differentiate patients with CLI who are free from MALEs.</p><p>Conclusions: The modified ACD-GENE-CLI score could differentiate patients with CLI receiving clopidogrel who are at risk of MALEs. Further studies are required to generalize the utility of the score.</p>

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