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Most patients with critical limb ischemia (CLI) exhibit severe comorbidities accompanied by frailty. This study assessed and risk-stratified mortality after infrainguinal bypass (IB) in CLI and investigated the effects of frailty.Methods and Results:The study retrospectively reviewed 107 consecutive CLI patients who had undergone de novo IB due to atherosclerotic disease. Data regarding patient age, comorbidities, laboratory data, and functional status were collected; functional status was evaluated using the Barthel index (BI) and nutritional status was evaluated using albumin concentrations and body mass index (BMI). Mean (±SD) BI and BMI were 75±16 and 22±4 kg/m 2 , respectively. BI (hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.94-0.99, P=0.004), BMI (HR 0.85; 95% CI 0.75-0.95, P=0.003), atrial fibrillation (AF; HR 5.31; 95% CI 2.12-13.30, P&lt;0.001), and ejection fraction (EF; HR 0.94; 95% CI 0.91-0.98, P=0.003) were independent predictors of mortality. Patients were divided into 2 groups based on BI (BI &gt;75, n=71; and BI &lt;70, n=36). Survival after IB was significantly lower for the lower BI group (P&lt;0.001, log-rank test). After propensity score matching, post-IB survival remained significantly lower in the lower BI group (P=0.02).

circulation journal

Association Between Preoperative Frailty and Mortality in Patients With Critical Limb Ischemia Following Infrainguinal Bypass Surgery ― Usefulness of the Barthel Index ―