{"doi":"10.1161/circinterventions.118.006778","title":"Impact of Frailty on Clinical Outcomes in Patients With Critical Limb Ischemia","abstract":"<jats:sec>\n            <jats:title>Background:</jats:title>\n            <jats:p>The predictive ability of patient frailty on clinical outcomes after revascularization in patients with critical limb ischemia remains largely unknown.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:</jats:title>\n            <jats:p>\n              We enrolled 643 patients with critical limb ischemia treated with endovascular therapy (N=486) or bypass surgery (N=157) in January 2010 to January 2016, and prospectively assessed them using a 9-level clinical frailty scale (CFS). Patients were divided into 3 groups according to CFS levels: low (CFS level, 1–3; N=234), intermediate (CFS level, 4–6; N=196), and high (CFS level, 7–9; N=213) groups. Clinical follow-up rate was 95.8% at 2 years. In the low, intermediate, and high CFS groups, 2-year overall survival rates were 80.5%, 63.1%, and 49.3% (\n              <jats:italic>P</jats:italic>\n              &lt;0.001) and amputation-free survival rates were 77.9%, 60.5%, and 46.2% (\n              <jats:italic>P</jats:italic>\n              &lt;0.001), respectively. In multivariable analysis, higher frailty was independently associated with all-cause death (intermediate CFS group: adjusted hazard ratio, 1.64; 95% confidence interval, 1.12–2.42;\n              <jats:italic>P</jats:italic>\n              =0.01; high CFS group: adjusted hazard ratio, 2.22; 95% confidence interval, 1.52–3.23;\n              <jats:italic>P</jats:italic>\n              &lt;0.001) and a composite of all-cause death and major amputation (intermediate CFS group: adjusted hazard ratio, 1.72; 95% confidence interval, 1.19–2.48;\n              <jats:italic>P</jats:italic>\n              =0.004; high CFS group: adjusted hazard ratio, 2.34; 95% confidence interval, 1.64–3.35;\n              <jats:italic>P</jats:italic>\n              &lt;0.001). Frailty was also independently associated with overall survival and amputation-free survival in patients aged ≤75 and &gt;75 years, those who underwent endovascular therapy or bypass surgery, and those with or without chronic renal failure, without significant interactions.\n            </jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:</jats:title>\n            <jats:p>Frailty was independently associated with 2-year overall survival and amputation-free survival in patients with critical limb ischemia treated with revascularization, irrespective of age, revascularization mode, and chronic renal failure status.</jats:p>\n          </jats:sec>","journal":"Circulation: Cardiovascular Interventions","year":2018,"id":16688,"datarank":4.495821553389592,"base_score":4.653960350157523,"endowment":4.653960350157523,"self_citation_contribution":0.6980940525236285,"citation_network_contribution":3.7977275008659634,"self_endowment_contribution":0.6980940525236285,"citer_contribution":3.7977275008659634,"corpus_percentile":null,"corpus_rank":null,"citation_count":104,"citer_count":97,"citers_with_citation_signal":75,"citers_with_endowment":75,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":122292,"name":"Kyohei Yamaji","orcid":null,"position":1,"is_corresponding":false},{"id":122293,"name":"Yusuke Tomoi","orcid":null,"position":2,"is_corresponding":false},{"id":122294,"name":"Jin Okazaki","orcid":null,"position":3,"is_corresponding":false},{"id":122295,"name":"Kiyoshi Tanaka","orcid":null,"position":4,"is_corresponding":false},{"id":122296,"name":"Ayumu Nagae","orcid":null,"position":5,"is_corresponding":false},{"id":122297,"name":"Hiroyuki Jinnouchi","orcid":null,"position":6,"is_corresponding":false},{"id":122298,"name":"Seiichi Hiramori","orcid":null,"position":7,"is_corresponding":false},{"id":122299,"name":"Yoshimitsu Soga","orcid":null,"position":8,"is_corresponding":false},{"id":122300,"name":"Kenji Ando","orcid":null,"position":9,"is_corresponding":false},{"id":122291,"name":"Yasuaki Takeji","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"base_score":4.653960350157523,"endowment":4.653960350157523,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"30006333","pmcid":null,"openalex_id":"https://openalex.org/W2883017972","authors":[],"funders":[],"total_grants":0,"fwci":9.2096,"citation_percentile":0.98555419,"influential_citations":7,"citation_trend":[{"year":2018,"count":3},{"year":2019,"count":8},{"year":2020,"count":11},{"year":2021,"count":17},{"year":2022,"count":13},{"year":2023,"count":17},{"year":2024,"count":22},{"year":2025,"count":10},{"year":2026,"count":3}],"oa_status":"closed","license":null,"oa_locations":[{"url":"https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.118.006778","host_type":"publisher"},{"url":"https://doi.org/10.1161/circinterventions.118.006778","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/30006333","host_type":"repository"}],"fields_of_study":["Peripheral Artery Disease Management","Stroke Rehabilitation and Recovery","Acute Ischemic Stroke Management","Medicine","Aged","Aged, 80 and over","Amputation, Surgical","Cause of Death","Critical Illness","Endovascular Procedures","Female","Frail Elderly","Frailty","Geriatric Assessment","Health Status","Humans","Ischemia","Limb Salvage","Male","Middle Aged","Peripheral Arterial Disease","Progression-Free Survival","Prospective Studies","Risk Assessment","Risk Factors","Time Factors","Vascular Grafting"],"mesh_terms":["Frailty","Progression-Free Survival","Aged","Aged, 80 and over","Amputation, Surgical","Cause of Death","Female","Health Status","Humans","Ischemia","Male","Middle Aged","Prospective Studies","Risk Factors","Time Factors","Geriatric Assessment","Frail Elderly","Critical Illness","Risk Assessment","Limb Salvage","Endovascular Procedures","Vascular Grafting","Peripheral Arterial Disease"],"keywords":["Medicine","Critical limb ischemia","Ischemia","Limb ischemia","Intensive care medicine","Internal medicine","Cardiology","Revascularization","Myocardial infarction","Survival","rate","Frailty","Peripheral Arterial Disease","Amputation Valve"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-06-02T13:10:29.769633Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}