Risk-Prediction Model of Restenosis after Endovascular Treatment for Peripheral Arterial Disease: A Systematic Review and Meta-analysis.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Xiaoyan Quan, Yang Liu, Huarong Xiong, Pan Song, Dan Wang, Xiaoyu Liu, Qin Chen, Xiaoli Hu, Meihong Shi
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引用次数: 0

Abstract

Background: Peripheral artery disease (PAD) patients after endovascular treatment (EVT) have a relatively high restenosis rate. However, this risk can be mitigated through precise risk assessment and individualized self-management intervention plans. Moreover, the number of predictive models for restenosis risk in PAD patients after EVT is gradually increasing, yet these results of study exhibit certain discrepancies, raising uncertainties regarding the quality and applicability in clinical practice and future research.

Objective: The objective of this study was to systematically evaluate risk-predictive models for restenosis in patients with PAD after EVT.

Methods: A systematic review and meta-analysis of predictive model construction and validation using observational studies was undertaken. The China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, SinoMed, PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to January 1, 2024. Two researchers independently conducted literature screening and data extraction, encompassing study design, data sources, outcome definition, sample size, predictive factors, model development, and performance. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used for risk of bias and applicability assessment of the models.

Results: A total of 4275 studies were retrieved, ultimately resulting in the inclusion of 7 articles comprising 7 predictive models for restenosis in PAD patients after EVT, with a restenosis incidence ranging from 21.8% to 39.7%. The total sample size of the included models ranged from 137 to 1578 cases, with logistic regression analysis being the most commonly used modeling method. All models were built using R software. Only 2 models underwent external validation, and the reported area under the curve ranged from 0.728 to 0.864. The summary area-under-the-curve statistic was 0.80 (95% confidence interval [CI], 0.74-0.86), with an approximate prediction interval of 0.80 (95% CI, 0.62-0.91) . The number of included predictive factors ranged from 3 to 10, with the most common factors being age, Trans-Atlantic Inter-Society Consensus Ⅱ classification, hypertension, diabetes, high-sensitivity C-reactive protein, and surgical approach. All studies exhibited high risk of bias, primarily attributed to inappropriate sources of data and poor reporting of the analysis domain.

Conclusion: Predictive models for restenosis after EVT in PAD patients demonstrate overall good predictive performance but are still in the developmental stage with higher risk of bias. Future studies should follow the TRIPOD statement, focusing on the development of new models with larger samples, rigorous study designs, and multicenter external validation.

Clinical impact: This systematic review adheres to the PRISMA 2020 statement, offering the most recent systematic assessment of risk prediction models for restenosis following endovascular treatment in peripheral arterial disease.The newly developed PROBAST tool was employed to assess the risk of bias and the applicability of the existing evidence.This review emphasizes the practical utility, limitations of the current evidence, and recommendations for future research, with the goal of providing valuable information for clinicians and patients in their decision-making process, while also supporting the advancement of future research endeavors.

外周动脉疾病血管内治疗后再狭窄的风险预测模型:系统回顾与元分析》。
背景:接受血管内治疗(EVT)后的外周动脉疾病(PAD)患者再狭窄率相对较高。然而,通过精确的风险评估和个性化的自我管理干预计划可以降低这一风险。此外,EVT 后 PAD 患者再狭窄风险预测模型的数量也在逐渐增加,但这些研究结果显示出一定的差异,在临床实践和未来研究中的质量和适用性存在不确定性:本研究的目的是系统评估PAD患者EVT术后再狭窄的风险预测模型:方法:利用观察性研究对预测模型的构建和验证进行系统回顾和荟萃分析。研究人员检索了中国国家知识基础设施、中国科技期刊数据库、万方数据库、SinoMed、PubMed、Web of Science、Embase 和 Cochrane 图书馆从开始到 2024 年 1 月 1 日的所有文献。两名研究人员独立进行了文献筛选和数据提取,包括研究设计、数据来源、结果定义、样本大小、预测因素、模型开发和性能。预测模型偏倚风险评估工具(PROBAST)用于评估模型的偏倚风险和适用性:结果:共检索到 4275 项研究,最终纳入了 7 篇文章,包括 7 个预测模型,用于预测 EVT 后 PAD 患者的再狭窄情况,再狭窄发生率从 21.8% 到 39.7% 不等。纳入模型的总样本量从 137 例到 1578 例不等,逻辑回归分析是最常用的建模方法。所有模型均使用 R 软件建立。只有 2 个模型经过了外部验证,报告的曲线下面积从 0.728 到 0.864 不等。汇总的曲线下面积统计量为 0.80(95% 置信区间 [CI],0.74-0.86),近似预测区间为 0.80(95% CI,0.62-0.91)。纳入的预测因素从3个到10个不等,最常见的因素是年龄、跨大西洋学会间共识Ⅱ分类、高血压、糖尿病、高敏C反应蛋白和手术方式。所有研究的偏倚风险都很高,主要归因于数据来源不当和分析领域报告不全:结论:PAD 患者 EVT 术后再狭窄的预测模型总体表现良好,但仍处于发展阶段,存在较高的偏倚风险。未来的研究应遵循 TRIPOD 声明,重点开发具有更大样本、严格研究设计和多中心外部验证的新模型:本系统性综述遵循 PRISMA 2020 声明,对外周动脉疾病血管内治疗后再狭窄的风险预测模型进行了最新的系统性评估。本综述强调了现有证据的实用性、局限性以及对未来研究的建议,旨在为临床医生和患者的决策过程提供有价值的信息,同时也支持未来研究工作的推进。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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