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Article

Mid-Term Mortality Prediction Using Four Established Risk Scores in Patients with Chronic Limb-Threatening Ischemia Undergoing Cardiac Surgery

1
Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
2
Department of Vascular Surgery, Asahikawa Medical University, Asahikawa 078-8510, Japan
*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(17), 6210; https://doi.org/10.3390/jcm14176210
Submission received: 13 August 2025 / Revised: 27 August 2025 / Accepted: 1 September 2025 / Published: 2 September 2025

Abstract

Objectives: Patients with chronic limb-threatening ischemia (CLTI) represent a high-risk cohort for cardiac surgery due to the systemic atherosclerotic burden and frailty. This study aimed to evaluate the short- and mid-term prognoses of CLTI patients undergoing open cardiac surgery and to assess the prognostic utility of four risk scoring systems: Japan SCORE, SPINACH SCORE, Clinical Frailty Scale (CFS), and Geriatric Nutritional Risk Index (GNRI). Methods: We retrospectively analyzed 44 patients with CLTI who underwent open cardiac surgery between 2014 and 2023. Thirty-day and 1-year mortality were assessed. Patients were stratified using ROC-derived cutoffs for each scoring system. Kaplan–Meier survival curves and time-dependent ROC analyses were used to evaluate predictive performance over time. Results: Thirty-day mortality was significantly associated with a higher Japan SCORE; survivors had significantly lower scores than non-survivors (5.5% vs. 25.8%, p < 0.05). One-year mortality was significantly associated with nutritional status, as survivors showed a significantly higher GNRI than non-survivors (92.0 vs. 86.0, p < 0.05). Time-dependent ROC analysis revealed that the GNRI and SPINACH SCORE’s sustained prognostic accuracy beyond 1 year. Calibration plots showed good agreement between predicted and observed probabilities for the SPINACH SCORE and GNRI, while decision curve analysis (DCA) demonstrated that these two models provided greater net clinical benefit across a range of thresholds, particularly in the 5–20% range. Conclusions: Japan SCORE is effective for short-term risk prediction, while SPINACH SCORE and GNRI offer superior prognostic value for mid-term outcomes. These scoring systems may support preoperative risk stratification and decision-making in CLTI patients undergoing cardiac surgery.
Keywords: chronic limb-threatening ischemia; cardiac surgery; risk stratification; Japan SCORE; SPINACH SCORE; GNRI; frailty; mortality chronic limb-threatening ischemia; cardiac surgery; risk stratification; Japan SCORE; SPINACH SCORE; GNRI; frailty; mortality

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MDPI and ACS Style

Setogawa, Y.; Kikuchi, S.; Oyama, K.; Tsutsui, M.; Azuma, N.; Kamiya, H.; Kunioka, S. Mid-Term Mortality Prediction Using Four Established Risk Scores in Patients with Chronic Limb-Threatening Ischemia Undergoing Cardiac Surgery. J. Clin. Med. 2025, 14, 6210. https://doi.org/10.3390/jcm14176210

AMA Style

Setogawa Y, Kikuchi S, Oyama K, Tsutsui M, Azuma N, Kamiya H, Kunioka S. Mid-Term Mortality Prediction Using Four Established Risk Scores in Patients with Chronic Limb-Threatening Ischemia Undergoing Cardiac Surgery. Journal of Clinical Medicine. 2025; 14(17):6210. https://doi.org/10.3390/jcm14176210

Chicago/Turabian Style

Setogawa, Yuki, Shinsuke Kikuchi, Kyohei Oyama, Masahiro Tsutsui, Nobuyoshi Azuma, Hiroyuki Kamiya, and Shingo Kunioka. 2025. "Mid-Term Mortality Prediction Using Four Established Risk Scores in Patients with Chronic Limb-Threatening Ischemia Undergoing Cardiac Surgery" Journal of Clinical Medicine 14, no. 17: 6210. https://doi.org/10.3390/jcm14176210

APA Style

Setogawa, Y., Kikuchi, S., Oyama, K., Tsutsui, M., Azuma, N., Kamiya, H., & Kunioka, S. (2025). Mid-Term Mortality Prediction Using Four Established Risk Scores in Patients with Chronic Limb-Threatening Ischemia Undergoing Cardiac Surgery. Journal of Clinical Medicine, 14(17), 6210. https://doi.org/10.3390/jcm14176210

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