Abstract 9928: Risk Stratification for Amputation in Patients With Symptomatic Peripheral Artery Disease After Lower Extremity Revascularization: Insights From VOYAGER PAD
Bibliographic record
Abstract
Introduction: Amputation is a severe consequence of peripheral artery disease (PAD), and systems for risk stratification have been developed. The performance of these systems in trials of PAD patients after successful lower extremity revascularization (LER) and receiving modern medical therapies has not been well described. Hypothesis: Risk of amputation is associated with the Rutherford Chronic Limb Ischemia class as well as the wound, ischemia, and foot infection (WIfI) grade in patients with PAD after LER. Methods: Patients in the VOYAGER PAD trial were assigned a Rutherford class at baseline and follow up. A WIfI score was assigned by 2 vascular specialists blinded to outcome and treatment allocation. Incidence of the composite of first major or minor amputation through 3 years were calculated by risk group. Results: Of 6,564 randomized, Rutherford was available in 6543 and WIfI in 6471. Due to the trial’s inclusion criteria, no Rutherford 6/WIfI high risk were included. Despite successful LER, there was a stepwise increase in the risk of amputation (p<.001) with increasing baseline Rutherford classification (Figure 1A) with incidence at 3 years of 22.4% in Rutherford 5. Risk was also associated with WIfI (Figure 1B); however, those classified as “very low” risk still a 15% incidence of amputation. When stratified by diabetes mellitus (DM), those with DM were at higher risk in all WIfI classes. Those with DM classified as "very low" risk had a higher incidence of amputation than patients without DM stratified as “moderate risk”. Conclusions: In a large clinical trial of patients with symptomatic PAD post successful LER, high incidences of amputation were observed despite contemporary medical therapies. In patients eligible for the study, Rutherford and WIfI both stratify risk; however, those with WIfI “very low” risk still had high incidences of amputation. Risk in those with DM was higher in each WIfI class suggesting that this could be considered in risk stratification.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".