Senthong Vichai, Wu Yuping, Hazen Stanley L, Tang W H Wilson
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH; Queen Sirikit Heart Center of the Northeast, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Mathematics, Cleveland State University, Cleveland, OH.
Am Heart J. 2017 Feb;184:17-25. doi: 10.1016/j.ahj.2016.10.009. Epub 2016 Oct 20.
The ability of a simple self-assessment tool for estimated functional capacity to predict long-term prognosis in patients with established peripheral artery disease (PAD) is unknown. We investigate whether subjective measurement of functional capacity estimated by using the Duke Activity Status Index (DASI) questionnaire predicts long-term prognosis in patients with established PAD.
We administered the DASI questionnaire to 771 stable patients with established PAD who underwent elective diagnostic coronary angiography with 5-year follow-up all-cause mortality.
Two hundred ten patients (27%) died over a 5-year follow-up. The lowest DASI score was associated with a 3.2-fold increased risk of 5-year all-cause mortality (unadjusted hazard ratio 3.23, 95% CI 2.19-4.75, P<.001). After adjustments for traditional risk factors, estimated glomerular filtration rate, high-sensitivity C-reactive protein, and lowest DASI score remained predictive of 5-year all-cause mortality (adjusted hazard ratio 2.09, 95% CI 1.36-3.23, P<.001). Interestingly, the lowest DASI score remained to predict 5-year all-cause mortality regardless of each PAD diagnosis subtype (including lower extremity, non-lower extremity, or carotid artery PAD), although the mortality risk was attenuated when incorporating heart disease severity in the non-lower extremity group.
A simple self-assessment tool of functional capacity provides an independent and incremental prognosis value for long-term adverse clinical events in stable patients with established PAD beyond each PAD diagnostic subtype.
一种用于评估功能能力的简单自我评估工具预测已确诊外周动脉疾病（PAD）患者长期预后的能力尚不清楚。我们调查使用杜克活动状态指数（DASI）问卷进行的功能能力主观测量是否能预测已确诊PAD患者的长期预后。
我们对771例稳定的已确诊PAD患者进行了DASI问卷调查，这些患者接受了选择性诊断性冠状动脉造影，并进行了5年全因死亡率随访。
在5年的随访中，210例患者（27%）死亡。最低的DASI评分与5年全因死亡率风险增加3.2倍相关（未调整的风险比为3.23，95%可信区间为2.19-4.75，P<0.001）。在对传统危险因素、估计肾小球滤过率、高敏C反应蛋白进行调整后，最低的DASI评分仍然是5年全因死亡率的预测指标（调整后的风险比为2.09，95%可信区间为1.36-3.23，P<0.001）。有趣的是，无论PAD诊断亚型如何（包括下肢、非下肢或颈动脉PAD），最低的DASI评分仍然可以预测5年全因死亡率，尽管在非下肢组纳入心脏病严重程度时死亡风险有所降低。
一种简单的功能能力自我评估工具为已确诊PAD的稳定患者长期不良临床事件提供了独立且额外的预后价值，超越了每种PAD诊断亚型。
