A prognostic risk index for long-term mortality in patients with peripheral arterial disease
A prognostic risk index for long-term mortality in patients with peripheral arterial disease
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DOI：
10.1001/archinte.167.22.2482
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发表时间：
2007-12-10
影响因子：
--
通讯作者：
Poldermans, Don
中科院分区：
文献类型：
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作者：
Feringa, Harm H. H.;Bax, Jeroen J.;Poldermans, Don
背景：外周动脉疾病(PAD)的预后信息可能为早期最佳治疗策略提供依据。本研究旨在开发PAD患者长期死亡率的预后风险指数。方法：在一项单中心观察性队列研究中，2642例踝臂指数小于或等于0.90的患者被随机分为派生组(n=1332)和验证组(n=1310)。逐步向后剔除的COX回归分析确定了派生队列中1年、5年和10年死亡率的预测因素。每个预测者都被分配了加权点。结果：在10年的随访中，分别有42.2%和40.4%的患者在派生和验证队列中死亡。10年死亡率(+分)的危险指数包括肾功能不全(+12)、心力衰竭(+7)、ST段改变(+5)、年龄>65岁(+5)、高胆固醇血症(+5)、踝臂指数<0.60(+4)、Q波(+4)、糖尿病(+3)、脑血管疾病(+3)和肺部疾病(+3)。他汀类药物(-6)、阿司匹林(-4)和β-受体阻滞剂(-4)与降低10年死亡率相关。根据风险评分，患者被分成低(<；0分)、低-中(0-5分)、高-中(6-9分)和高(>；9分)风险类别。10年死亡率分别为22.1%、32.2%、45.8%和70.4%(P
Background: Prognostic information in peripheral arterial disease ( PAD) may provide the basis for optimal management strategies at an early stage. This study aimed to develop a prognostic risk index for long-term mortality in patients with PAD.Methods: In a single-center observational cohort study, 2642 patients with an ankle-brachial index of 0.90 or lower were randomly divided into derivation (n=1332) and validation (n=1310) cohorts. Cox regression analysis with stepwise backward elimination identified predictors of 1-year, 5-year, and 10-year mortality in the derivation cohort. Weighted points were assigned to each predictor. Index discrimination was determined in both the derivation and validation cohorts.Results: During 10 years of follow-up, 42.2% and 40.4% of patients died in the derivation and validation cohorts, respectively. The risk index for 10-year mortality (+points) included renal dysfunction (+12), heart failure (+7), ST-segment changes (+5), age greater than 65 years (+5), hypercholesterolemia (+5), ankle-brachial index lower than 0.60 (+4), Q-waves (+4), diabetes (+3), cerebrovascular disease (+3), and pulmonary disease (+3). Statins (-6), aspirin (-4), and beta-blockers (-4) were associated with reduced 10-year mortality. Patients were stratified into low (< 0 points), low- intermediate (0-5 points), high-intermediate (6-9 points), and high (> 9 points) risk categories, according to risk score. Ten-year mortality rates were 22.1%, 32.2%, 45.8%, and 70.4%, respectively (P