Schaller Melinda S, Ramirez Joel L, Gasper Warren J, Zahner Greg J, Hills Nancy K, Grenon S Marlene
Department of Surgery, University of California, San Francisco, San Francisco, CA.
Department of Surgery, University of California, San Francisco, San Francisco, CA; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, CA.
Ann Vasc Surg. 2018 Jul;50:38-45. doi: 10.1016/j.avsg.2017.12.002. Epub 2018 Mar 26.
Frailty, a syndrome characterized by decreased physiologic reserves and resistance to stressors, is associated with disability, poor surgical outcomes, and mortality. We evaluated the impact of frailty on cardiovascular disease (CVD) events in peripheral arterial disease (PAD) patients with intermittent claudication.
We conducted a retrospective review of patients with stable intermittent claudication enrolled in the OMEGA-PAD study between 2010 and 2015. The modified frailty index (mFI) is a retrospectively validated index of frailty derived from the Canadian Study of Health and Aging and was used in this study to categorize frailty as low, medium, or high. Our outcome was time to occurrence of a major adverse cardiac event (MACE), defined as a composite endpoint of myocardial infarction, coronary revascularization, stroke, or CVD-related death. Cox proportional hazards models were used to calculate relative hazards ratio.
There were 129 subjects with a mean age of 67 years, 97% were men, 36% were diabetic, and 33% had known coronary heart disease. When the mFI criteria were applied, 38 subjects were "low" frailty, 72 were "medium" frailty, and 19 were "high" frailty. During the median follow-up period of 34 months (interquartile range: 25-43), 29 subjects experienced a MACE. When compared to the lowest mFI, patients with medium frailty were 2.8 times more likely to have an event (95% confidence interval [CI]: 0.95-8.46, P = 0.06), whereas patients with a high mFI were 4.8 times as likely (95% CI: 1.43-15.8, P = 0.01). In a model adjusted for age, smoking status, and presence of diabetes, those with a medium mFI were 4.3 times more likely to have an event (95% CI: 1.37-13.7, P = 0.01) and those with a high mFI were 9.2 times as likely (95% CI: 2.6-32.4, P = 0.001).
Higher mFI category is associated with a significantly increased risk of MACE in PAD patients with stable claudication. Frailty may serve as a useful adjunct for assessment of overall cardiac risk, particularly as treatment options are being contemplated.
衰弱是一种以生理储备减少和对应激源的抵抗力下降为特征的综合征，与残疾、手术效果不佳及死亡率相关。我们评估了衰弱对间歇性跛行的外周动脉疾病（PAD）患者心血管疾病（CVD）事件的影响。
我们对2010年至2015年纳入OMEGA-PAD研究的稳定间歇性跛行患者进行了回顾性分析。改良衰弱指数（mFI）是一项经回顾性验证的衰弱指数，源自加拿大健康与老龄化研究，本研究中用于将衰弱分为低、中、高三个等级。我们的研究终点是首次发生主要不良心脏事件（MACE）的时间，MACE定义为心肌梗死、冠状动脉血运重建、中风或CVD相关死亡的复合终点。采用Cox比例风险模型计算相对风险比。
共有129名受试者，平均年龄67岁，97%为男性，36%患有糖尿病，33%患有冠心病。应用mFI标准时，38名受试者为“低”度衰弱，72名受试者为“中”度衰弱，19名受试者为“高”度衰弱。在34个月的中位随访期内（四分位间距：25 - 43个月），29名受试者发生了MACE。与最低mFI组相比，中度衰弱患者发生事件的可能性高2.8倍（95%置信区间[CI]：0.95 - 8.46，P = 0.06），而高度衰弱患者发生事件的可能性高4.8倍（95% CI：1.43 - 15.8，P = 0.01）。在对年龄、吸烟状况和糖尿病进行校正的模型中，中度mFI患者发生事件的可能性高4.3倍（95% CI：1.37 - 13.7，P = 0.01），高度mFI患者发生事件的可能性高9.2倍（95% CI：2.6 - 32.4，P = 0.001）。
在稳定型间歇性跛行的PAD患者中，较高的mFI等级与MACE风险显著增加相关。衰弱可能是评估总体心脏风险的有用辅助指标，尤其是在考虑治疗方案时。
