Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
BMC Cardiovasc Disord. 2021 Aug 2;21(1):370. doi: 10.1186/s12872-021-02177-1.
Among changes in demographics, aging is the most relevant cardiovascular risk factor. The prevalence of peripheral artery disease (PAD) is high in elderly patients and is associated with a worse prognosis. Despite optimal treatments, mortality in the high-risk population of octo- and nonagenarians with PAD remains excessive, and predictive factors need to be identified. The objective of this study was to investigate predictors of mortality in octo- and nonagenarians with PAD.
Cases of treated octo- and nonagenarians, including the clinical characteristics and markers of myocardial injury and heart failure, were studied retrospectively with respect to all-cause mortality. Hazard ratios [HR] were calculated and survival was analyzed by Kaplan-Meyer curves and receiver operating characteristic curved were assessed for troponin-ultra and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and chronic limb-threatening ischemia (CLTI).
A total of 123 octo- and nonagenarians admitted for PAD were eligible. The troponin level was the major predictor of all-cause mortality (HR: 4.6, 95% confidence interval [CI]: 1.4-15.3), followed by the NT-proBNP level (HR: 3.9, 95% CI 1.8-8.8) and CLTI (HR: 3.1, 95% CI 1.6-5.9). Multivariate regression revealed that each increment of 1 standard deviation in log troponin and log NT-proBNP was associated with a 2.7-fold (95% CI 1.8-4.1) and a 1.9-fold (95% CI 1.2-2.9) increased risk of all-cause death. Receiver operating characteristic curve analysis using a combination of all predictors yielded an improved area under the curve of 0.888. In a control group of an equal number of younger individuals, only NT-proBNP (HR: 4.2, 95% CI 1.2-14.1) and CLTI (HR: 6.1, 95% CI 1.6-23.4) were predictive of mortality.
Our study demonstrates that cardiovascular biomarkers and CLTI are the primary predictors of increased mortality in elderly PAD patients. Further risk stratification through biomarkers in this high-risk population of octo- and nonagenarians with PAD is necessary.
在人口结构变化中，老龄化是最重要的心血管危险因素。高龄患者外周动脉疾病（PAD）的患病率较高，且预后较差。尽管进行了最佳治疗，患有 PAD 的 80 岁及以上超高龄人群的死亡率仍然过高，需要确定预测因素。本研究旨在探讨 PAD 高龄患者（80 岁及以上）死亡的预测因素。
回顾性研究了接受治疗的 80 岁及以上高龄患者的病例，包括所有原因死亡率的临床特征和心肌损伤和心力衰竭标志物。计算了风险比（HR），并通过 Kaplan-Meier 曲线和接受者操作特征曲线分析了肌钙蛋白-超敏（troponin-ultra）和 N 末端脑钠肽前体（NT-proBNP）水平以及慢性肢体威胁性缺血（CLTI）对生存率的影响。
共有 123 名因 PAD 入院的 80 岁及以上高龄患者符合条件。肌钙蛋白水平是全因死亡率的主要预测因素（HR：4.6，95%置信区间[CI]：1.4-15.3），其次是 NT-proBNP 水平（HR：3.9，95% CI 1.8-8.8）和 CLTI（HR：3.1，95% CI 1.6-5.9）。多变量回归显示，log 肌钙蛋白和 log NT-proBNP 每增加 1 个标准差，全因死亡的风险分别增加 2.7 倍（95% CI 1.8-4.1）和 1.9 倍（95% CI 1.2-2.9）。使用所有预测因子的组合进行接受者操作特征曲线分析，曲线下面积提高至 0.888。在年龄相等的对照组中，只有 NT-proBNP（HR：4.2，95% CI 1.2-14.1）和 CLTI（HR：6.1，95% CI 1.6-23.4）与死亡率相关。
本研究表明，心血管生物标志物和 CLTI 是 PAD 高龄患者死亡风险增加的主要预测因素。在患有 PAD 的超高龄人群中，通过生物标志物进行进一步的风险分层是必要的。
