Robert and Suzanne Tomsich Department of Cardiovascular Disease, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, Weston, Florida.
Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, United Kingdom.
Am J Cardiol. 2024 Mar 1;214:144-148. doi: 10.1016/j.amjcard.2023.08.036. Epub 2024 Feb 1.
Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) benefit from disease-modifying agents such as tafamidis. However, the survival benefit of tafamidis in elderly patients (age ≥80 years) is not reported. This study aimed to assess the survival of patients with ATTR-CM aged 80 years and older who were treated with tafamidis compared with patients aged <80 years. We conducted a retrospective analysis of patients with ATTR-CM who underwent tafamidis treatment, aged 45 to 97 years at the time of diagnosis between January 1, 2008, and May 31, 2021. A total of 484 patients were included, with 208 in the ≥80 years group and 276 in the <80 years group. The cohort was followed up for mortality outcomes, and hazard ratios with 95% confidence intervals were calculated. After a median follow-up of 18.5 months, 72 deaths were recorded in the entire cohort. Kaplan-Meier curves showed no differences in survival probability between the 2 groups at 30 months (p for log-rank test = 0.76). The survival rates for patients aged ≥80 years who underwent treatment at 1, 2, 3, 4, and 5 years were 94.7%, 86.0%, 77.0%, 77.0%, and 38.5%, respectively. The corresponding rates for patients aged <80 years who underwent treatment were 93.2, 84.8, 74.4, 68.2, and 64.6%, respectively. In the multivariable analysis, the hazard ratio (95% confidence interval) of the mortality comparing treatment patients aged ≥80 years with those aged <80 years was 0.81 (0.41 to 1.61). In conclusion, tafamidis treatment is associated with similar reductions in mortality in older and younger patients with ATTR-CM.
转甲状腺素蛋白淀粉样变性心肌病（ATTR-CM）患者从塔法米迪等疾病修饰药物中获益。然而，塔法米迪在 80 岁以上老年患者中的生存获益尚未报道。本研究旨在评估与年龄<80 岁的患者相比，接受塔法米迪治疗的 80 岁及以上 ATTR-CM 患者的生存情况。我们对 2008 年 1 月 1 日至 2021 年 5 月 31 日期间诊断时年龄为 45 至 97 岁的接受塔法米迪治疗的 ATTR-CM 患者进行了回顾性分析。共纳入 484 例患者，其中≥80 岁组 208 例，<80 岁组 276 例。对全队列进行死亡率随访，并计算风险比及其 95%置信区间。中位随访 18.5 个月后，全队列共记录 72 例死亡。Kaplan-Meier 曲线显示两组在 30 个月时的生存概率无差异（log-rank 检验 p 值=0.76）。年龄≥80 岁接受治疗的患者在 1、2、3、4 和 5 年的生存率分别为 94.7%、86.0%、77.0%、77.0%和 38.5%，年龄<80 岁接受治疗的患者的生存率分别为 93.2%、84.8%、74.4%、68.2%和 64.6%。多变量分析中，年龄≥80 岁与年龄<80 岁接受治疗的患者的死亡率的风险比（95%置信区间）为 0.81（0.41 至 1.61）。总之，塔法米迪治疗可使 ATTR-CM 老年和年轻患者的死亡率降低。
