Prevent III score as a long-term limb and mortality predictor after aortoiliac revascularization - a prospective study

Abstract

Background: The multifaceted spectrum of aortoiliac occlusive disease, characterized by atherosclerotic supra-inguinal vessel obstruction, underscores the need for meticulous risk stratification in guiding clinical interventions for patients, balancing the complexities of limb and cardiovascular risk. This prospective study aimed to validate the prognostic value of Prevent III (PIII) risk score in patients undergoing aortoiliac revascularization, both in limb-related outcomes and cardiovascular risk. Methods: The prospective cohort study included patients undergoing elective aortoiliac revascularization between January 2013 and September 2022 at two medical centers. Patients' demographic and clinical characteristics were retrieved and PIII scores were calculated. A risk category was assigned according to the total points: low-risk (score ≤3), medium-risk (score 4-7), or high-risk (score ≥8). Results: The cohort comprised 130 patients (mean age: 62.1±9.16 years). Among these, 122 (93.8%) were male, and the median follow-up period was 55 months. Twenty-four patients had a PIII score ≥4 (18.5%). Regarding short-term outcomes, patients with PIII scores ≥4 exhibited lower ankle-brachial index changes at 30 days and more extended hospital stays. There were no significant associations between PIII scores and major adverse events at 30 days. However, during follow-up, a PIII score ≥4 was associated with increased major adverse limb events (p=0.036) and all-cause mortality (p=0.007). Conclusion: The PIII score emerges as a reliable predictor of long-term limb and mortality risk in patients undergoing aortoiliac revascularization procedures, leveraging five user-friendly clinical parameters. More research with larger cohorts and studies comparing PIII with other validated scores should be performed in the future.