Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio.
Faculty of Pharmacy, Ho Chi Minh City University of Technology - HUTECH, Vietnam.
J Gerontol A Biol Sci Med Sci. 2021 Jul 13;76(8):1524-1530. doi: 10.1093/gerona/glab006.
Little is known on the incidence and postoperative outcomes of revascularizations according to electivity in persons with Alzheimer's disease (AD).
The Medication Use and Alzheimer's disease (MEDALZ) cohort includes 70 718 community dwellers diagnosed with incident AD during 2005-2011 in Finland. For each person with AD, 1-4 age-, sex-, and hospital district-matched comparison persons without AD were identified. Altogether 448 persons with AD and 5909 without AD underwent revascularization during the follow-up. The outcomes were 30-day and 90-day re-admission rate after discharge, and all-cause 1-year and 3-year mortality. Risk of outcomes in persons with AD were compared to those without AD using Cox proportional hazard models adjusted with age, sex, comorbidities, statin use, revascularization type, length of stay, and support at discharge.
People with AD had less revascularizations (adjusted hazard ratio 0.24, 95% confidence interval 0.22-0.27). Emergency procedures were more common (42.6% vs 33.1%) than elective procedures (34.2% vs 48.6%) among people with AD. There was no difference in 30-day readmissions (0.97, 0.80-1.17) or 1-year mortality (1.04, 0.75-1.42) and 90 days readmission risk was lower in persons with AD (0.85, 0.74-0.98). People with AD had higher 3-year mortality (1.42, 1.15-1.74), but the risk increase was observed only for emergency (1.71, 1.27-2.31), not for elective procedures (0.96, 0.63-1.46).
People with AD did not have worse readmission and mortality outcomes following elective revascularization. These findings in conjunction with lower revascularization rate especially for elective procedures raise questions on the threshold for elective procedures in people with AD.
在阿尔茨海默病（AD）患者中，根据选择性进行血运重建的发病率和术后结果知之甚少。
该研究的药物使用和阿尔茨海默病（MEDALZ）队列包括 70718 名在芬兰于 2005-2011 年期间被诊断为新发 AD 的社区居住者。对于每位 AD 患者，均确定了 1-4 名年龄、性别和医院区域匹配的无 AD 对照者。共有 448 名 AD 患者和 5909 名非 AD 患者在随访期间接受了血运重建。结果是出院后 30 天和 90 天的再入院率，以及全因 1 年和 3 年死亡率。使用 Cox 比例风险模型对 AD 患者与非 AD 患者的结局进行比较，该模型调整了年龄、性别、合并症、他汀类药物使用、血运重建类型、住院时间和出院时的支持。
AD 患者的血运重建次数较少（调整后的危险比 0.24，95%置信区间 0.22-0.27）。AD 患者的急诊手术更为常见（42.6%比 33.1%），而非择期手术（34.2%比 48.6%）更为常见。30 天内再入院率无差异（0.97，0.80-1.17）或 1 年死亡率（1.04，0.75-1.42），AD 患者的 90 天再入院风险较低（0.85，0.74-0.98）。AD 患者的 3 年死亡率较高（1.42，1.15-1.74），但这种风险增加仅见于急诊手术（1.71，1.27-2.31），而非择期手术（0.96，0.63-1.46）。
AD 患者进行选择性血运重建后，再入院和死亡率结果并不差。这些发现加上特别是择期手术的血运重建率较低，引发了人们对 AD 患者进行择期手术的门槛的质疑。
