Aortic & peripheral vascular disease
Prediction of 1-Year Major Adverse Cardiovascular Events in Chronic Limb Threatening Ischemia
Authors' conclusion
The BEST-CLI MACE model predicts 1-year MACE in CLTI, is not influenced by mode of revascularization, and highlights the importance of statin therapy. Further work is needed to determine if this model may be helpful in guiding therapeutic decision-making in CLTI patients.
Study context
- Population
- Patients with chronic limb threatening ischemia (CLTI) participating in the BEST-CLI trial
- Participants
- 1,780 patients
- Comparison
- BEST-CLI MACE model predicting 1-year MACE, with internal (derivation/validation) and external (BEST Registry) validation
- Outcome
- Cumulative incidence of MACE
- Follow-up
- 1-year
Methodological detailsrandomly split 80%/20% into derivation and validation cohorts, parsimonious multivariable model, External validation was performed in the observational BEST Registry
- Randomly split 80%/20% into derivation and validation cohorts
- Parsimonious multivariable model
- External validation was performed in the observational BEST Registry
Performance
As reported in the abstract
1-year cumulative incidence of MACE
17.33%
95% CI 15.59%–19.24%
Further findings
Predictors of 1-year MACE
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| Prior coronary artery diseaseModel performance was driven by nonmodifiable risk factors | 2.22 (1.72–2.89) | P < 0.0001 | |
| Congestive heart failureModel performance was driven by nonmodifiable risk factors | 1.93 (1.35–2.75) | P = 0.0003 | |
| Stage 3 or greater chronic kidney diseaseModel performance was driven by nonmodifiable risk factors | 1.46 (1.14–1.87) | P = 0.0025 | |
| Statin useProtective · Model performance was driven by nonmodifiable risk factors | 0.7 (0.54–0.91) | P = 0.007 | |
| 0.20.5125Hazard ratio (log scale) |
- Mode of revascularization was not protective
Baseline characteristics
- Average age
- 67.2 years
- Female
- 28.3%
- Black
- 20.2%
- Hypertension
- 87.1%
- Hyperlipidemia
- 73.9%
- Diabetes
- 69.2%
- Coronary artery disease
- 44.9%
Model performance
- C-statistic
- 0.669
- Calibration slope
- 0.884
- Overall model discrimination and calibration were good
External validation in the BEST Registry
- C-statistic
- 0.66
- Calibration slope
- 0.78
- Observational BEST Registry, subset of 40 BEST-CLI trial sites
Original publication
Prediction of 1-Year Major Adverse Cardiovascular Events in Chronic Limb Threatening Ischemia. JACC Adv. Published 21 July 2025. doi:10.
Summarised from the published abstract; every number is checked against it