Higuchi Satoshi, Kabeya Yusuke, Matsushita Kenichi, Taguchi Hiroki, Ishiguro Haruhisa, Kohshoh Hideyasu, Yoshino Hideaki
Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan.
Division of General Internal Medicine, Department of Internal Medicine, Tokai University Hachioji Hospital, Tokyo, Japan.
Clin Cardiol. 2016 Feb;39(2):83-9. doi: 10.1002/clc.22497. Epub 2015 Dec 31.
Percutaneous coronary intervention (PCI) is safe and effective in very elderly patients, defined as those who are age ≥85 years, with acute coronary syndrome (ACS). However, the prognostic factors remain unknown. The association between activities of daily living (ADL) and the prognosis after PCI has not yet been investigated.
Better ADL is associated with better 1-year prognosis.
This retrospective study included 91 consecutive very elderly patients with ACS. We calculated the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to BI: high BI (≥85) and low BI (<85). The BI was assessed both on admission (pre-BI) and at discharge (post-BI).
In the 91 patients (mean age, 88.2 ± 3.0 years, 52% male), 1-year mortality was 33%. The Cox regression model demonstrated that low pre-BI was not a risk factor for 1-year mortality (hazard ratio: 0.73, 95% confidence interval [CI]: 0.30-1.78, P = 0.490). However, post-BI was significantly associated with 1-year mortality (hazard ratio: 0.25, 95% CI: 0.11-0.57, P = 0.001). The 1-year mortality of the high and the low post-BI group was estimated as 21% (95% CI: 12%-35%) and 62% (95% CI: 42%-82%), respectively. A 5-unit decrease in post-BI was related to a 1.10-fold increased risk for 1-year mortality (95% CI: 1.05-1.15, P < 0.001).
Activities of daily living at discharge, although not before admission, may be a useful predictor for 1-year mortality in very elderly patients undergoing PCI for ACS.
经皮冠状动脉介入治疗（PCI）对于年龄≥85岁的急性冠状动脉综合征（ACS）老年患者是安全有效的。然而，其预后因素仍不明确。日常生活活动能力（ADL）与PCI术后预后之间的关联尚未得到研究。
较好的ADL与较好的1年预后相关。
这项回顾性研究纳入了91例连续的老年ACS患者。我们计算了Barthel指数（BI）作为ADL的指标。根据BI将患者分为两组：高BI组（≥85）和低BI组（<85）。在入院时（术前BI）和出院时（术后BI）对BI进行评估。
91例患者（平均年龄88.2±3.0岁，52%为男性），1年死亡率为33%。Cox回归模型显示，术前低BI不是1年死亡率的危险因素（风险比：0.73，95%置信区间[CI]：0.30-1.78，P = 0.490）。然而，术后BI与1年死亡率显著相关（风险比：0.25，95% CI：0.11-0.57，P = 0.001）。术后高BI组和低BI组的1年死亡率分别估计为21%（95% CI：12%-35%）和62%（95% CI：42%-82%）。术后BI每降低5个单位与1年死亡率风险增加1.10倍相关（95% CI：1.05-1.15，P < 0.001）。
对于接受PCI治疗ACS的老年患者，出院时的日常生活活动能力，而非入院前的，可能是1年死亡率的有用预测指标。
