Vascular medicine department, groupe hospitalier Paris Saint-Joseph, Paris, France; Inserm UMR 1153-CRESS, université Paris Descartes, Paris, France.
Medical information department, groupe hospitalier Paris Saint-Joseph, Paris, France.
J Med Vasc. 2021 Oct-Dec;46(5-6):224-231. doi: 10.1016/j.jdmv.2021.10.003. Epub 2021 Nov 5.
Patients with critical limb ischemia (CLI) present with advanced age and end-stage organ damage, in particular heart failure. The aim of the present study is to describe clinical and biological characteristics in octogenarian patients with CLI compared to their younger counterparts and to determine the peri-procedural risk and early mortality after endovascular procedure.
From November 2013 to May 2019, 315 consecutive patients were retrospectively included. Clinical and biological parameters were recorded at baseline before endovascular revascularization. The main outcome was total 1-year mortality.
The study included 170 octogenarians and 145 non-octogenarians. The mean age of octogenarian patients was 86.9±4.8 years, almost 20 years higher than that registered in non-octagenarians patients (67.4±8.6 years). Octogenarian patients were mostly women (59.4%), presented with lower body mass index (23.8±4.4kg/m), lower serum albumin level (31.5±5.4g/L) and lower creatinine clearance (66.1±24.5mL/mn) than younger counterparts. They were more likely to be institutionalized in a nursing home (27.1%). In the peri-procedural period, major bleeding occurred in 40 patients (12.7%), without statistical significance between the two age groups. Peri-procedural mortality occurred in 12 patients (3.8%), of whom 10 patients (83%) were octogenarians. Cumulative mortality rate was 25.4% (80 patients) during the one-year follow-up period: 58 octogenarians died (34.1%) compared to 22 non-octogenarian patients (15.2%), P<0.001. Cardiovascular events were highly prevalent, accounting for 40% of overall mortality. Twenty-five patients (8%) experienced major amputation, without significant difference between the two age groups. In octogenarian population, institutionalized status (P=0.004) and BNP level (P=0.001) were positively correlated with mortality whereas systolic blood pressure (P<0.001), left ventricular ejection fraction (P=0.003), serum albumin (P=0.020), C-Reactive protein (P=0.020) and renin-angiotensin system inhibitors at hospital discharge were negatively correlated with mortality. In multivariate analysis for mortality, only BNP level≥500pg/mL (HR 3.27; 95% CI 1.04-10.97; P=0.04), was correlated with mortality, independently of other confounders.
In the present study population, octogenarians represent a rather distinct CLI population, 20 years of age older as compared to non-octogenarians, with prevalent malnutrition and institutionalized status. The present results underline a substantial one-year mortality rate of 34.1% in this elderly population following revascularization procedure with a 6% peri-procedural mortality. Decompensated heart failure is an important contributor for mortality.
患有严重肢体缺血（CLI）的患者年龄较大，且存在终末期器官损伤，特别是心力衰竭。本研究的目的是描述与年轻患者相比，80 岁以上 CLI 患者的临床和生物学特征，并确定血管内治疗后围手术期风险和早期死亡率。
从 2013 年 11 月至 2019 年 5 月，回顾性纳入了 315 例连续患者。在血管内再血管化前记录临床和生物学参数。主要结局是总 1 年死亡率。
研究包括 170 名 80 岁以上的患者和 145 名非 80 岁以上的患者。80 岁以上患者的平均年龄为 86.9±4.8 岁，几乎比非 80 岁以上患者高 20 岁（67.4±8.6 岁）。80 岁以上患者女性居多（59.4%），体重指数（23.8±4.4kg/m）较低，血清白蛋白水平（31.5±5.4g/L）和肌酐清除率（66.1±24.5mL/mn）较低。他们更有可能在养老院（27.1%）中接受治疗。在围手术期，40 名患者（12.7%）发生大出血，但两组之间无统计学差异。12 名患者（3.8%）在围手术期死亡，其中 10 名患者（83%）为 80 岁以上患者。在 1 年的随访期间，累积死亡率为 25.4%（80 例）：58 名 80 岁以上患者死亡（34.1%），22 名非 80 岁以上患者死亡（15.2%），P<0.001。心血管事件发生率很高，占总死亡率的 40%。25 名患者（8%）接受了大截肢术，但两组之间无显著差异。在 80 岁以上人群中，住院状态（P=0.004）和 BNP 水平（P=0.001）与死亡率呈正相关，而收缩压（P<0.001）、左心室射血分数（P=0.003）、血清白蛋白（P=0.020）、C 反应蛋白（P=0.020）和肾素-血管紧张素系统抑制剂在出院时与死亡率呈负相关。在多变量死亡率分析中，只有 BNP 水平≥500pg/mL（HR 3.27；95%CI 1.04-10.97；P=0.04）与死亡率相关，独立于其他混杂因素。
在本研究人群中，80 岁以上患者年龄比非 80 岁以上患者大 20 岁，营养不良和住院状态较为普遍。本研究结果强调，在血管内治疗后，这一年龄较大的人群 1 年死亡率为 34.1%，围手术期死亡率为 6%。失代偿性心力衰竭是导致死亡率的一个重要因素。
