Decision-making in elderly patients with severe aortic stenosis:: why are so many denied surgery?
Decision-making in elderly patients with severe aortic stenosis:: why are so many denied surgery?
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DOI：
10.1093/eurheartj/ehi471
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发表时间：
2005-12-01
影响因子：
39.3
通讯作者：
Vahanian, A
中科院分区：
文献类型：
--
作者：
Iung, B;Cachier, A;Vahanian, A
目的分析老年患者的决策与严重的，有症状的主动脉瓣狭窄（AS）。方法和结果在欧洲心脏调查心脏瓣膜病，216例患者年龄≥ 75岁有严重的AS（瓣膜面积= 50毫米汞柱）和心绞痛或纽约心脏协会III级或IV级。根据是否手术的决定分析患者特征。72例患者（33%）决定不手术。在多变量分析中，左心室（LV）射血分数[OR=2.27，95%CI（1.32-3.97）射血分数30-50，OR=5.15，95% CI（1.73-15.35）对于射血分数50%，P=0.003]和年龄[OR=1.84，95%CI 80-85岁组为（1.18-2.89），OR=3.38，95%CI（1.38-8.27）>= 85岁vs. 75-80岁，P=0.008]与不手术的决定显著相关;然而，Charlson合并症指数则不是[OR=1.72，95%CI（0.83-3.50），P=0.14（指数>= 2 vs. < 2）]。神经功能障碍是唯一的并发症显着联系的决定不operation.Conclusion手术被拒绝在33%的老年患者严重的，有症状的AS。年龄较大和左室功能不全是拒绝手术的患者最显著的特征，而合并症起的作用较小。
Aims To analyse decision-making in elderly patients with severe, symptomatic aortic stenosis (AS).Methods and results In the Euro Heart Survey on valvular heart disease, 216 patients aged >= 75 had severe AS (valve area = 50 mmHg) and angina or New York Heart Association class III or IV. Patient characteristics were analysed according to the decision to operate or not. A decision not to operate was taken in 72 patients (33%). In multivariable analysis, left ventricular (LV) ejection fraction [OR=2.27, 95% CI (1.32-3.97) for ejection fraction 30-50, OR=5.15, 95% CI (1.73-15.35) for ejection fraction 50%, P=0.003] and age [OR=1.84, 95% CI (1.18-2.89) for 80-85 years, OR=3.38, 95% CI (1.38-8.27) for >= 85 vs. 75-80 years, P=0.008] were significantly associated with the decision not to operate; however, the Charlson comorbidity index was not [OR=1.72, 95% CI (0.83-3.50), P=0.14 for index >= 2 vs. < 2]. Neurological dysfunction was the only comorbidity significantly linked with the decision not to operate.Conclusion Surgery was denied in 33% of elderly patients with severe, symptomatic AS. Older age and LV dysfunction were the most striking characteristics of patients who were denied surgery, whereas comorbidity played a less important role.