Cockburn James, Kemp Tiffany, Ludman Peter, Kinnaird Tim, Johnson Tom, Curzen Nick, Robinson Derek, Mamas Mamas, de Belder Adam, Hildick-Smith David
Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Queen Elizabeth Hospital NHS Trust, Birmingham, UK.
Catheter Cardiovasc Interv. 2021 Dec 1;98(7):1300-1307. doi: 10.1002/ccd.29406. Epub 2020 Dec 6.
Octogenarians are a high-risk group presenting for percutaneous coronary intervention (PCI). We aimed to create a 30-day mortality risk model for octogenarians presenting with both acute coronary syndrome (ACS) and chronic stable angina (CSA), using comprehensive mandatory UK data submissions to the UK National database.
Octogenarians are a high-risk group presenting for percutaneous coronary intervention, and decisions on whether or not to undertake intervention in this cohort can be challenging. The increasing number of octogenarians in the general population means they represent an important high-risk subgroup of patients.
The data group consisted of 425,897 PCI procedures undertaken in the UK between 2008 and 2012 during which time there was comprehensive data linkage to mortality via the Office of National Statistics. Of these procedures, 44,221 (10.4%) were in patients aged ≥80. These comprised the model group. Logistic regression was used to create a predictive score which ultimately consisted of the following weightings: age 80-89 (n = 1); age > 90 (n = 2); unstable angina/non-ST-elevation myocardial infraction (NSTEMI) (n = 1); STEMI (n = 2); creatinine >200 mmol/L (n = 1); preprocedural ventilation (n = 1); left ventricular ejection fraction <30% (n = 1); cardiogenic shock (n = 2). Multiple imputation was used to account for missing data.
The patient cohort was divided into a derivation (n = 22,072) and a validation dataset (n = 22,071). Receiver operating characteristic analyses were used to derive the area-under-the-curve to assess properties of the score. The scoring system generated an AUC 0.83, (95% CI 0.80-0.85) suggesting high sensitivity and specificity. Scores of 1-4 were associated with good survival but scores ≥5 were associated with an estimated likelihood of death within 30 days of ≥40%.
This octogenarian risk score maybe a useful tool to determine the chance of a successful outcome in elderly patients presenting for PCI.
八旬老人是接受经皮冠状动脉介入治疗（PCI）的高危人群。我们旨在利用向英国国家数据库提交的全面强制性英国数据，为同时患有急性冠状动脉综合征（ACS）和慢性稳定型心绞痛（CSA）的八旬老人创建一个30天死亡风险模型。
八旬老人是接受经皮冠状动脉介入治疗的高危人群，决定是否对该人群进行干预可能具有挑战性。普通人群中八旬老人数量的增加意味着他们是一个重要的高危患者亚组。
数据组包括2008年至2012年期间在英国进行的425,897例PCI手术，在此期间通过国家统计局与死亡率进行了全面的数据关联。在这些手术中，44,221例（10.4%）是年龄≥80岁的患者。这些构成了模型组。使用逻辑回归创建一个预测评分，最终由以下权重组成：年龄80 - 89岁（n = 1）；年龄>90岁（n = 2）；不稳定型心绞痛/非ST段抬高型心肌梗死（NSTEMI）（n = 1）；ST段抬高型心肌梗死（STEMI）（n = 2）；肌酐>200 mmol/L（n = 1）；术前通气（n = 1）；左心室射血分数<30%（n = 1）；心源性休克（n = 2）。使用多重插补法处理缺失数据。
患者队列分为一个推导数据集（n = 22,072）和一个验证数据集（n = 22,071）。使用受试者工作特征分析来得出曲线下面积以评估评分的特性。评分系统生成的AUC为0.83（95%CI 0.80 - 0.8
