Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization.
Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization.
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DOI：
10.1161/circoutcomes.111.961375
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发表时间：
2011-09
期刊：
影响因子：
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通讯作者：
Roger VL
中科院分区：
文献类型：
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作者：
Singh M;Rihal CS;Lennon RJ;Spertus JA;Nair KS;Roger VL
虽然老年患者经常接受经皮冠状动脉介入治疗(PCI)，但虚弱、合并疾病和生活质量(QOL)很少是风险预测方法的一部分。我们在梅奥临床风险评分(MCRS)中评估了它们在风险因素之外的增量预后价值。对65岁接受经皮冠状动脉介入治疗的患者进行了虚弱(Fry标准)、共病(Charlson指数)和生活质量[SF-36]的评估。在出院的628人中[平均随访35.0个月(IQR，22.7-42.9)]，78人死亡，72人有心肌梗死。虚弱患者三年死亡率为28%，非虚弱患者为6%。3年死亡率和心肌梗死发生率分别为41%和17%。调整后，脆弱[危险比(HR)4.19[95%可信区间(CI)，1.85，9.51]、SF-36身体成分评分(HR，1.59；95%CI，1.24-2.02)和共病(HR，1.10；95%CI，1.05，1.16)与死亡率相关。衰弱与死亡率/心肌梗死相关(HR，2.61，1.52，4.50)。采用常规MCRS的模型死亡率和死亡率/MI的C统计量分别为0.628和0.573。加上虚弱、生活质量和合并症，死亡率的C统计量分别为(0.675，0.694，0.671)，死亡率/MI的C统计量分别为(0.607，0.587，0.576)。包括脆弱、合并症和SF-36在内，对死亡和死亡/MI的预测有明显的改善(综合辨别力改善0.027和0.016，净重新分类改善43%和18%)。在经皮冠状动脉介入治疗后，虚弱、合并症和不良的生活质量普遍存在，并与不良的长期结果相关。它们的纳入提高了从常规心血管危险因素得出的MCRS的区分能力。
While older patients frequently undergo percutaneous coronary interventions (PCI), frailty, comorbidity, and quality of life (QOL) are seldom part of risk prediction approaches. We assessed their incremental prognostic value over and above the risk factors in the Mayo Clinic risk score (MCRS). Patients ≥ 65 years who underwent PCI were assessed for frailty (Fried criteria), comorbidity (Charlson index), and QOL [SF-36]. Of the 628 discharged [median follow-up of 35.0 months (IQR, 22.7-42.9)], 78 died and 72 had an MI. Three year mortality was 28% for frail patients, 6% for non-frail patients. The respective 3-year rates of death or MI were 41% and 17%. Following adjustment, frailty [hazard ratio (HR) 4.19 [95% confidence interval (CI), 1.85, 9.51], physical component score of the SF-36 (HR, 1.59; 95% CI, 1.24-2.02), and comorbidity, (HR, 1.10; 95% CI, 1.05, 1.16) were associated with mortality. Frailty was associated with mortality/MI (HR, 2.61, 1.52, 4.50). Models with conventional MCRS had C-statistics of 0.628, 0.573 for mortality and mortality/MI respectively. Adding frailty, QOL, and comorbidity, the C statistic was (0.675, 0.694, 0.671) for mortality, and (0.607, 0.587, 0.576) for mortality/MI respectively. Including frailty, comorbidities, and SF-36, conferred a discernible improvement to predict death and death/MI (integrated discrimination improvement 0.027 and 0.016 and net reclassification improvement of 43% and 18% respectively). Following PCI, frailty, comorbidity and poor QOL are prevalent and are associated with adverse long-term outcomes. Their inclusion improves the discriminatory ability of the MCRS derived from the routine cardiovascular risk factors.