Ioannou Adam, Papageorgiou Nikolaos, Barber Harry, Falconer Debbie, Barra Sergio, Babu Girish, Ahsan Syed, Rowland Edward, Hunter Ross, Lowe Martin, Schilling Richard, Lambiase Pier, Chow Anthony, Providencia Rui
St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; University College of London Hospitals NHS Trust, London, United Kingdom.
St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
Am J Cardiol. 2017 Oct 1;120(7):1158-1165. doi: 10.1016/j.amjcard.2017.06.056. Epub 2017 Jul 14.
Age is an adverse prognostic factor in patients with heart failure. We aimed to assess the impact of age and noncardiac co-morbidities in the outcome of patients undergoing cardiac resynchronization therapy (CRT), and determine which of these two factors is the most important predictor of survival. The study involved a single-center retrospective assessment of 697 consecutive CRT implants during a 12-year period. Patient co-morbidity profile was assessed using the Charlson Co-morbidity Index (CCI) and the Charlson Age-Co-morbidity Index (CACI). Predictors of survival free from heart transplantation were assessed. CRT-related complications and cause of death analysis were assessed within tertiles of the CACI. During a mean follow-up of 1,813 ± 1,177 days, 347 patients (49.9%) died and 37 (5.3%) underwent heart transplantation. On multivariate Cox regression, female gender (HR = 0.78, 95% confidence interval [CI] 0.62 to 0.99, p = 0.041), estimated glomerular filtration rate (HR per ml/min = 0.99, 95% CI 0.98 to 0.99, p < 0.001), left ventricular ejection fraction (HR per % = 0.99, 95% CI 0.98 to 1.00, p = 0.022), New York Heart Association class (HR = 1.83, 95% CI 1.53 to 2.20, p < 0.001), presence of left bundle branch block (HR = 0.70, 95% CI 0.56 to 0.87, p = 0.001), and CACI tertile (HR = 1.37, 95% CI 1.18 to 1.59, p < 0.001) were independent predictors of all-cause mortality or heart transplantation. Compared with age and the CCI, the CACI was the best discriminator of all-cause mortality. Inappropriate therapies occurred less frequently in higher co-morbidity tertiles. In conclusion, patient co-morbidity profile adjusted to age impacts on mortality after CRT implantation. Use of the CACI may help refine guideline criteria to identify patients more likely to benefit from CRT.
年龄是心力衰竭患者的一个不良预后因素。我们旨在评估年龄和非心脏合并症对接受心脏再同步治疗（CRT）患者预后的影响，并确定这两个因素中哪一个是生存的最重要预测因素。该研究涉及对12年间连续697例CRT植入患者进行单中心回顾性评估。使用Charlson合并症指数（CCI）和Charlson年龄合并症指数（CACI）评估患者的合并症情况。评估无心脏移植生存的预测因素。在CACI三分位数范围内评估CRT相关并发症和死亡原因分析。在平均1813±1177天的随访期间，347例患者（49.9%）死亡，37例（5.3%）接受了心脏移植。在多因素Cox回归分析中，女性性别（HR = 0.78，95%置信区间[CI] 0.62至0.99，p = 0.041）、估计肾小球滤过率（每毫升/分钟HR = 0.99，95% CI 0.98至0.99，p < 0.001）、左心室射血分数（每百分比HR = 0.99，95% CI 0.98至1.00，p = 0.022）、纽约心脏协会分级（HR = 1.83，95% CI 1.53至2.20，p < 0.001）、左束支传导阻滞的存在（HR = 0.70，95% CI 0.56至0.87，p = 0.001）以及CACI三分位数（HR = 1.37，95% CI 1.18至1.59，p < 0.001）是全因死亡率或心脏移植的独立预测因素。与年龄和CCI相比，CACI是全因死亡率的最佳判别指标。在合并症较高的三分位数中，不适当治疗的发生率较低。总之，根据年龄调整的患者合并症情况会影响CRT植入后的死亡率。使用CACI可能有助于完善指南标准，以识别更可能从CRT中获益的患者。
