衰弱及其他老年病状况用于急性冠状动脉综合征老年患者的风险分层。

Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome.

机构信息

Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain.

出版信息

Am Heart J. 2014 Nov;168(5):784-91. doi: 10.1016/j.ahj.2014.07.022. Epub 2014 Jul 30.

DOI:10.1016/j.ahj.2014.07.022

PMID:25440808

Abstract

BACKGROUND

Geriatric conditions may predict outcomes beyond age and standard risk factors. Our aim was to investigate a wide spectrum of geriatric conditions in survivors after an acute coronary syndrome.

METHODS

A total of 342 patients older than 65 years were included. At hospital discharge, 5 geriatric conditions were evaluated: frailty (Fried and Green scores), physical disability (Barthel index), instrumental disability (Lawton-Brody scale), cognitive impairment (Pfeiffer questionnaire), and comorbidity (Charlson and simple comorbidity indexes). The outcomes were postdischarge mortality and the composite of death/myocardial infarction during a 30-month median follow-up.

RESULTS

Seventy-four (22%) patients died and 105 (31%) suffered from the composite end point. Through univariable analysis, all individual geriatric indexes were associated with outcomes, mainly mortality. Of all of them, frailty using the Green score had the strongest discriminative accuracy (area under the receiver operating characteristic curve 0.76 for mortality). After full adjustment including clinical and geriatric data, the Green score was the only independent predictive geriatric condition (per point; mortality: hazard ratio 1.25, 95% CI 1.15-1.36, P = .0001; composite end point: hazard ratio 1.16, 95% CI 1.09-1.24, P = .0001). A Green score ≥ 5 points was the strongest mortality predictor. The addition of the Green score to the clinical model improved discrimination (area under the receiver operating characteristic curve 0.823 vs 0.846) and significantly reclassified mortality risk (net reclassification improvement 26.3, 95% CI 1.4-43.5; integrated discrimination improvement 4.0, 95% CI 0.8-9.0). The incremental predictive information was even greater over the GRACE score.

CONCLUSIONS

Frailty captures most of the prognostic information provided by geriatric conditions after acute coronary syndromes. The Green score performed better than the other geriatric indexes.

摘要

背景

老年病状况可能预测年龄和标准风险因素以外的结果。我们的目的是研究急性冠状动脉综合征后幸存者中广泛的老年病状况。

方法

共纳入 342 名年龄大于 65 岁的患者。在出院时，评估了 5 种老年病状况：衰弱（Fried 和 Green 评分）、身体残疾（Barthel 指数）、工具性残疾（Lawton-Brody 量表）、认知障碍（Pfeiffer 问卷）和合并症（Charlson 和简单合并症指数）。结果是出院后 30 个月中位随访期间的死亡率和死亡/心肌梗死的复合终点。

结果

74 例（22%）患者死亡，105 例（31%）发生复合终点事件。通过单变量分析，所有个体老年病指标均与结局相关，主要是死亡率。在所有这些指标中，使用 Green 评分的衰弱具有最强的区分准确性（死亡率的受试者工作特征曲线下面积为 0.76）。在包括临床和老年病数据的完全调整后，Green 评分是唯一独立的预测性老年病状况（每点；死亡率：危险比 1.25，95%CI 1.15-1.36，P=.0001；复合终点：危险比 1.16，95%CI 1.09-1.24，P=.0001）。Green 评分≥5 分是最强的死亡率预测指标。将 Green 评分添加到临床模型中提高了区分度（受试者工作特征曲线下面积为 0.823 比 0.846），并显著重新分类了死亡率风险（净重新分类改善 26.3，95%CI 1.4-43.5；综合鉴别改善 4.0，95%CI 0.8-9.0）。相对于 GRACE 评分，增量预测信息更大。