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    Prognostic nutritional index versus cally, conut, and car for predicting restenosis after endovascular treatment of superficial femoral artery chronic total occlusion
    (Elsevier, 2026) İskender, Hakan; Kılıç, Ömer Abdulbaki; Jabrayilzade, Jabrayil; Veyisoğlu, İbrahim; Toprak, Cüneyt; Çakmak, Ender Özgün
    Background: Inflammation- and nutrition-based indices have been associated with adverse outcomes after peripheral endovascular interventions, but their comparative performance re mains unclear. We compared the associations and discriminatory performance of the prognostic nutritional index (PNI), C-reactive protein—albumin—lymphocyte (CALLY) index, controlling nutritional status (CONUT) score, and C-reactive protein-to-albumin ratio (CAR) in relation to 6-month restenosis after endovascular treatment of superficial femoral artery chronic total occlu sion (SFA CTO). Methods: This retrospective cohort included 227 technically successful SFA CTO procedures performed between 2015 and 2021 with imaging-based 6-month restenosis assessment. The 4 indices were compared using receiver operating characteristic analysis and separate multivari able logistic regression models adjusted for clinical and lesion-related factors. Multiplicity correc tion and patient-cluster bootstrap internal validation were performed. Results: Restenosis occurred in 79 procedures (34.8%). PNI showed the highest discrimination (area under the curve [AUC] 0.728; 95% confidence interval [CI]: 0.662—0.794), compared with CONUT (0.625), CALLY (0.582), and CAR (0.568). After multivariable adjustment and multiplic ity correction, PNI (adjusted odds ratio [OR] 2.72 per 1-SD worsening; 95% CI 1.78—4.14) and CONUT (adjusted OR 1.61; 95% CI 1.17—2.22) remained independently associated with reste nosis, whereas CALLY and CAR did not. Adding PNI to the clinical base model increased the AUC from 0.670 to 0.782 and reduced the Brier score from 0.209 to 0.178. The improvement persisted after bootstrap validation (optimism-corrected AUC 0.740).