Sachdev Molly, Sun Jie Lena, Tsiatis Anastasios A, Nelson Charlotte L, Mark Daniel B, Jollis James G
Duke Clinical Research Institute, Duke University, Durham, North Carolina 27705, USA.
J Am Coll Cardiol. 2004 Feb 18;43(4):576-82. doi: 10.1016/j.jacc.2003.10.031.
To identify the prevalent and prognostically important coexisting illnesses among single coronary artery disease (CAD) patients.
As the population ages, physicians are increasingly required to make decisions concerning patients with multiple co-existing illnesses (comorbidity). Many trials of CAD therapy have excluded patients with significant comorbidity, such that there are limited data to guide the management of those patients.
To consider the long-term prognostic importance of comorbid illness, we examined a cohort of 1471 patients with CAD who underwent cardiac catheterization between 1985 and 1989 and were followed up through 2000 in the Duke Databank for Cardiovascular Diseases. Weights were assigned to individual diseases according to their prognostic significance in Cox proportional hazards models, thus creating a new CAD-specific index. The new index was compared with the widely used Charlson index, according to prevalence of conditions, individual and overall associations with survival, and agreement.
The Charlson index and the CAD-specific index were highly associated with long-term survival and almost equivalent to left ventricular ejection fraction. When considering the components of the Charlson index, diabetes, renal insufficiency, chronic obstructive pulmonary disease, and peripheral vascular disease had greater prognostic significance among CAD patients, whereas peptic ulcer disease, connective tissue disease, and lymphoma were less significant. Hemiplegia, leukemia, lymphoma, severe liver disease, and acquired immunodeficiency syndrome were rarely identified among patients undergoing coronary angiography.
Comorbid disease is strongly associated with long-term survival in patients with CAD. These data suggest co-existing illnesses should be measured and considered in clinical trials, disease registries, quality comparisons, and counseling of individual patients.
确定单支冠状动脉疾病（CAD）患者中普遍存在且对预后具有重要意义的并存疾病。
随着人口老龄化，医生越来越需要对患有多种并存疾病（合并症）的患者做出决策。许多CAD治疗试验都排除了患有严重合并症的患者，因此指导这些患者管理的数据有限。
为了考量合并症的长期预后重要性，我们研究了1985年至1989年间接受心脏导管插入术且在杜克心血管疾病数据库中随访至2000年的1471例CAD患者队列。根据个体疾病在Cox比例风险模型中的预后意义为其分配权重，从而创建一个新的CAD特异性指数。根据疾病的患病率、个体及总体与生存的关联以及一致性，将新指数与广泛使用的Charlson指数进行比较。
Charlson指数和CAD特异性指数与长期生存高度相关，且几乎等同于左心室射血分数。在考量Charlson指数的组成部分时，糖尿病、肾功能不全、慢性阻塞性肺疾病和外周血管疾病在CAD患者中具有更大的预后意义，而消化性溃疡疾病、结缔组织病和淋巴瘤的意义较小。在接受冠状动脉造影的患者中很少发现偏瘫、白血病、淋巴瘤、严重肝病和获得性免疫缺陷综合征。
合并症与CAD患者的长期生存密切相关。这些数据表明，在临床试验、疾病登记、质量比较以及个体患者咨询中，应测量并考虑并存疾病。
