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. 2023 Feb 11;13(2):316.
doi: 10.3390/jpm13020316.

Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

Eugenio Martelli  1   2   3 , Matilde Zamboni  4 , Giovanni Sotgiu  5 , Laura Saderi  5 , Massimo Federici  6 , Giuseppe M Sangiorgi  7 , Mariangela V Puci  5 , Allegra R Martelli  8 , Teresa Messina  9 , Paolo Frigatti  10 , Maria Pia Borrelli  10 , Carlo Ruotolo  11 , Ilaria Ficarelli  11 , Paolo Rubino  12 , Francesco Pezzo  12 , Luciano Carbonari  13 , Andrea Angelini  13 , Edoardo Galeazzi  14 , Luca Calia Di Pinto  14 , Franco M Fiore  15 , Armando Palmieri  15 , Giorgio Ventoruzzo  16 , Giulia Mazzitelli  16 , Franco Ragni  17 , Antonio Bozzani  17 , Enzo Forliti  18 , Claudio Castagno  18 , Pietro Volpe  19 , Mafalda Massara  19 , Diego Moniaci  20 , Elisa Pagliasso  20 , Tania Peretti  20 , Mauro Ferrari  21 , Nicola Troisi  21 , Piero Modugno  22 , Maurizio Maiorano  22 , Umberto M Bracale  23 , Marco Panagrosso  23 , Mario Monaco  24   25 , Giovanni Giordano  25 , Giuseppe Natalicchio  26 , Antonella Biello  26 , Giovanni M Celoria  27 , Alessio Amico  27 , Mauro Di Bartolo  27 , Massimiliano Martelli  28 , Roberta Munaó  28 , Davide Razzano  29 , Giovanni Colacchio  30 , Francesco Bussetti  30 , Gaetano Lanza  31 , Antonio Cardini  31 , Bartolomeo Di Benedetto  32 , Mario De Laurentis  32 , Maurizio Taurino  33   34 , Pasqualino Sirignano  1   34 , Pierluigi Cappiello  35 , Andrea Esposito  35 , Santi Trimarchi  36   37 , Silvia Romagnoli  37 , Andrea Padricelli  3 , Giorgio Giudice  3 , Adolfo Crinisio  38 , Giovanni Di Nardo  38 , Giuseppe Battaglia  39 , Rosario Tringale  39 , Salvatore De Vivo  40 , Rita Compagna  40 , Valerio S Tolva  41 , Ilenia D'Alessio  41 , Ruggiero Curci  42 , Simona Giovannetti  42 , Giuseppe D'Arrigo  43 , Giusi Basile  43 , Dalmazio Frigerio  44 , Gian Franco Veraldi  45 , Luca Mezzetto  45 , Arnaldo Ippoliti  7 , Fabio M Oddi  7 , Alberto M Settembrini  37
Affiliations

Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

Eugenio Martelli et al. J Pers Med. .

Abstract

Background: Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI).

Methods: Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included.

Follow-up: One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated.

Results: Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66-80) and 79 (71-85) years for men/women, respectively (p < 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p < 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p < 0.0001), dyslipidemia (69.3% vs. 61.3%, p < 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p < 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p < 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p < 0.0001), and minor amputations (22% vs. 13.7%, p < 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age > 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age > 75 (HR = 2.14, p < 0.0001), nephropathy (HR = 1.54, p < 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p < 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics.

Conclusion: Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes.

Keywords: age; chronic limb-threatening ischemia; limb salvage; outcome; sex.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for overall survival at 30 days. (A) Distribution of overall survival (B) Overall survival for males and females.
Figure 2
Figure 2
Kaplan–Meier curves for overall survival at 1 year. (A) Distribution of overall survival (B) Overall survival for males and females.
See this image and copyright information in PMC

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