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

doi:10.5551/jat.64326

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Title:	Utility of the ACD-GENE-CLI Score in Asian Patients with Critical Limb Ischemia Undergoing Endovascular Interventions
Authors:	Chang, Wei-Ting Huang, Po-Sen Su, Li-Wei Liao, Chia-Te Toh, Han Siong Chen, Yi-Chen Ho, Chung-Han Chen, Zhih-Cherng Hsu, Po -Chao Hong, Chon-Seng
Contributors:	Natl Sun Yat Sen Univ, Sch Med Natl Sun Yat Sen Univ, Coll Med, Doctoral Program Clin & Expt Med Natl Sun Yat Sen Univ, Ctr Excellence Metab Associated Fatty Liver Disong, Chon-Seng Chi Mei Med Ctr, Dept Internal Med, Div Cardiol Natl Sun Yat Sen Univ, Coll Med, Sch Med Univ Leuven, KU Leuven, Res Unit Hypertens & Cardiovasc Epidemiol, Studies Coordinating Ctr,Dept Cardiovasc Sci Chi Mei Med Ctr, Dept Intens Care Med Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr Chi Mei Med Ctr, Dept Med Res Southern Taiwan Univ Sci & Technol, Dept Informat Management Kaohsiung Med Univ Hosp, Dept Internal Med, Div Cardiol Kaohsiung Med Univ, Sch Med, Fac Med, Dept Internal Med Chi Mei Med Ctr, Dept Internal Med, Div Cardiol
Keywords:	ACD-GENE-CLI score Critical limb ischemia Clopidogrel
Date:	2024
Issue Date:	2024-12-25 11:05:18 (UTC+8)
Publisher:	JAPAN ATHEROSCLEROSIS SOC
Abstract:	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.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.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.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.
Relation:	Journal of Atherosclerosis And Thrombosis, v.31, n.5, pp.572-586
Appears in Collections:	[Offices] 456

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