Yousef Sameh, Amabile Andrea, Huang Huang, Agarwal Ritu, Singh Saket, Ram Chirag, Milewski Rita K, Assi Roland, Zhang Yawie, Krane Markus, Geirsson Arnar, Vallabhajosyula Prashanth
Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT 06510, USA.
Section of Surgical Outcomes and Epidemiology, Yale School of Public Health, New Haven, CT 06510, USA.
J Clin Med. 2022 May 23;11(10):2949. doi: 10.3390/jcm11102949.
(1) Background: Our goal was to develop a risk prediction model for mortality in patients with moderate and severe aortic stenosis (AS). (2) Methods: All patients aged 40−95 years, with echocardiographic evidence of moderate and severe AS at a single institution, were studied over a median of 2.8 (1.5−4.8) years, between 2013−2018. Patient characteristics and mortality were compared using Chi-squares, t-tests, and Kaplan−Meier (KM) curves, as appropriate. The risk calculation for mortality was derived using the Cox proportional hazards model. A risk score was calculated for each parameter, and the total sum of scores predicted the individualized risks of 1-and 5-year mortality. (3) Results: A total of 1991 patients with severe and 2212 with moderate AS were included. Severe AS patients were older, had a lower ejection fraction %, were more likely to be Caucasian, and had lower rates of obesity and smoking, but had higher rates of cardiac comorbidities and AVR (49.3% vs. 2.8%, p < 0.0001). The unadjusted overall mortality was 41.7% vs. 41%, p = 0.6530, and was not different using KM curves (log rank, p = 0.0853). The models included only patients with complete follow-up (3966 in the 1-year, and 816 in the 5-year model) and included 13 variables related to patient characteristics, degree of AS, and AVR. The C-statistic was 0.75 and 0.72 for the 1-year and the 5-year models, respectively. (4) Conclusions: Patients with moderate and severe AS experience high morbidity and mortality. The usage of a risk prediction model may provide guidance for clinical decision making in complex patients.
(1) 背景：我们的目标是开发一种用于中重度主动脉瓣狭窄（AS）患者死亡率的风险预测模型。(2) 方法：对2013年至2018年期间在单一机构中年龄在40 - 95岁、有中重度AS超声心动图证据的所有患者进行了研究，中位随访时间为2.8（1.5 - 4.8）年。根据情况，使用卡方检验、t检验和Kaplan - Meier（KM）曲线比较患者特征和死亡率。死亡率的风险计算采用Cox比例风险模型。为每个参数计算风险评分，评分总和预测1年和5年死亡率的个体风险。(3) 结果：共纳入1991例重度AS患者和2212例中度AS患者。重度AS患者年龄更大，射血分数更低，更可能是白种人，肥胖和吸烟率更低，但心脏合并症和主动脉瓣置换术（AVR）发生率更高（49.3% 对2.8%，p < 0.0001）。未调整的总死亡率分别为41.7%和41%，p = 0.6530，使用KM曲线时无差异（对数秩检验，p = 0.0853）。模型仅纳入了有完整随访的患者（1年模型中有3966例，5年模型中有816例），并纳入了13个与患者特征、AS程度和AVR相关的变量。1年和5年模型的C统计量分别为0.75和0.72。(4) 结论：中重度AS患者有较高的发病率和死亡率。风险预测模型的使用可为复杂患者的临床决策提供指导。
