Cardiology Department, Reina Sofía University Hospital, Córdoba, Spain.
Eur J Clin Invest. 2013 Aug;43(8):774-82. doi: 10.1111/eci.12105. Epub 2013 May 9.
This study aimed to assess long-term prognosis of stable coronary artery disease (sCAD) in patients aged ≥ 75 years and to identify clinical predictors of cardiovascular and overall mortality.
From February 2000 to January 2007, 391 outpatients aged ≥ 75 years (median 78 years, interquartile range [IQR] 76-81 years, 66% male) with sCAD were recruited in this prospective cohort study. Associations of baseline variables with long-term cardiovascular and all-cause death were investigated.
After up to 11 years of follow-up (median 4 years, IQR 2-6 years), 89 patients died (23%, 5·45%/year), 35 from cardiovascular causes (9%, 2·14%/year). Multivariate analysis identified family history of coronary disease (HR 4·28, 95% CI 1·22-15·02, P = 0·02), baseline atrial fibrillation (HR 3·18, 95% CI 1·37-7·39, P = 0·007), age (HR 1·61 per 5 year increase, 95% CI 1·04-2·50, P = 0·03), resting heart rate (HR 1·26 per 5 bpm increase, 95% CI 1·09-1·47, P = 0·003) and previous revascularization (HR 0·17, 95% CI 0·04-0·77, P = 0·02) as independent predictors of cardiovascular death, and previous acute coronary syndrome (HR 4·93, 95% CI 1·49-16·30, P = 0·009), baseline atrial fibrillation (HR 1·96, 95% CI 1·12-3·43, P = 0·02), tobacco use (HR 1·69, 95% CI 1·00-2·84, P = 0·049 for ex-smoking and HR 6·78, 95% CI 0·89-51·47, P = 0·06 for active smoking), age (HR 1·58 per 5 year increase, 95% CI 1·18-2·11, P = 0·002), resting heart rate (HR 1·10 per 5 bpm increase, 95% CI 1·00-1·22, P = 0·05) and diastolic blood pressure (HR 0·97, 95% CI 0·94-0·99, P = 0·01) as independent predictors of overall mortality.
In this study, 4-years overall mortality was 23% among elderly patients with sCAD. Simple clinical variables can identify patients at higher risk of mortality.
本研究旨在评估≥75 岁稳定型冠状动脉疾病（sCAD）患者的长期预后，并确定心血管和全因死亡率的临床预测因素。
从 2000 年 2 月至 2007 年 1 月，共招募了 391 名≥75 岁的门诊患者（中位年龄 78 岁，四分位距 [IQR] 76-81 岁，66%为男性）进行这项前瞻性队列研究。分析了基线变量与长期心血管和全因死亡的关系。
在最长达 11 年的随访（中位随访时间为 4 年，IQR 2-6 年）中，89 例患者死亡（23%，5.45%/年），35 例死于心血管疾病（9%，2.14%/年）。多变量分析确定了冠心病家族史（HR 4.28，95%CI 1.22-15.02，P=0.02）、基线心房颤动（HR 3.18，95%CI 1.37-7.39，P=0.007）、年龄（每增加 5 岁 HR 增加 1.61，95%CI 1.04-2.50，P=0.03）、静息心率（HR 每增加 5 bpm 增加 1.26，95%CI 1.09-1.47，P=0.003）和既往血运重建（HR 0.17，95%CI 0.04-0.77，P=0.02）是心血管死亡的独立预测因素，而既往急性冠状动脉综合征（HR 4.93，95%CI 1.49-16.30，P=0.009）、基线心房颤动（HR 1.96，95%CI 1.12-3.43，P=0.02）、吸烟史（HR 1.69，95%CI 1.00-2.84，P=0.049 为曾经吸烟者，HR 6.78，95%CI 0.89-51.47，P=0.06 为当前吸烟者）、年龄（每增加 5 岁 HR 增加 1.58，95%CI 1.18-2.11，P=0.002）、静息心率（HR 每增加 5 bpm 增加 1.10，95%CI 1.00-1.22，P=0.05）和舒张压（HR 0.97，95%CI 0.94-0.99，P=0.01）是全因死亡率的独立预测因素。
在这项研究中，≥75 岁的 sCAD 患者 4 年的总死亡率为 23%。简单的临床变量可以识别出死亡风险较高的患者。
