Medical School of Chinese PLA, Beijing, 100039, China.
Department of Cardiology, The Second Medical Center & National Clinical Research, Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China.
Eur J Med Res. 2024 Jun 15;29(1):330. doi: 10.1186/s40001-024-01929-x.
Ischemic cardio-cerebrovascular disease is the leading cause of mortality worldwide. However, studies focusing on elderly and very elderly patients are scarce. Hence, our study aimed to characterize and investigate the long-term prognostic implications of ischemic cardio-cerebrovascular diseases in elderly Chinese patients.
This retrospective cohort study included 1026 patients aged ≥ 65 years who were categorized into the mono ischemic cardio-cerebrovascular disease (MICCD) (either coronary artery disease or ischemic stroke/transient ischemic attack) (n = 912) and the comorbidity of ischemic cardio-cerebrovascular disease (CICCD) (diagnosed with both coronary artery disease and ischemic stroke/transient ischemic attack at admission) (n = 114). The primary outcome was all-cause death. The mortality risk was evaluated using the Cox proportional hazards risk model with multiple adjustments by conventional and propensity-score-based approaches.
Of the 2494 consecutive elderly patients admitted to the hospital, 1026 (median age 83 years [interquartile range]: 76.5-86.4; 94.4% men) met the inclusion criteria. Patients with CICCD consisted mostly of very elderly (79.2% vs. 66.1%, P < 0.001) individuals with a higher burden of comorbidities. Over a median follow-up of 10.4 years, 398 (38.8%) all-cause deaths were identified. Compared with the MICCD group, the CICCD group exhibited a higher adjusted hazard ratio (HR) (95% confidential interval, CI) of 1.71 (1.32-2.39) for long-term mortality after adjusting for potential confounders. The sensitivity analysis results remained robust. After inverse probability of treatment weighting (IPTW) modeling, the CICCD group displayed an even worse mortality risk (IPTW-adjusted HR: 2.07; 95% CI 1.47-2.90). In addition, anemia (adjusted HR: 1.48; 95% CI 1.16-1.89) and malnutrition (adjusted HR: 1.43; 95% CI 1.15-1.78) are also independent risk factors for all-cause mortality among elderly and very elderly patients.
Our results thus suggest that elderly patients with ischemic cardio-cerebrovascular disease and anemia or malnutrition may have higher mortality, which may be predicted upon admission. These findings, however, warrant further investigation.
缺血性心脑血管疾病是全球范围内导致死亡的主要原因。然而，针对老年和非常老年患者的研究却很少。因此，我们的研究旨在描述和探讨中国老年患者缺血性心脑血管疾病的长期预后意义。
本回顾性队列研究纳入了 1026 名年龄≥65 岁的患者，这些患者分为单发性缺血性心脑血管疾病（MICCD）（即冠状动脉疾病或缺血性中风/短暂性脑缺血发作）（n=912）和缺血性心脑血管疾病合并症（CICCD）（入院时同时诊断出冠状动脉疾病和缺血性中风/短暂性脑缺血发作）（n=114）。主要结局为全因死亡。使用 Cox 比例风险模型通过常规和倾向评分匹配方法进行多因素调整，评估死亡率风险。
在连续收治的 2494 名老年患者中，有 1026 名（中位年龄 83 岁[四分位距：76.5-86.4]；94.4%为男性）符合纳入标准。CICCD 患者主要为非常老年（79.2%比 66.1%，P<0.001）人群，合并症负担更高。在中位随访 10.4 年后，共确定 398 例（38.8%）全因死亡。与 MICCD 组相比，CICCD 组在调整了潜在混杂因素后，长期死亡率的调整后危险比（HR）（95%置信区间，CI）更高，为 1.71（1.32-2.39）。敏感性分析结果仍然稳健。在进行逆概率治疗加权（IPTW）建模后，CICCD 组的死亡率风险更高（IPTW 调整后的 HR：2.07；95%CI 1.47-2.90）。此外，贫血（调整后的 HR：1.48；95%CI 1.16-1.89）和营养不良（调整后的 HR：1.43；95%CI 1.15-1.78）也是老年和非常老年患者全因死亡的独立危险因素。
因此，我们的研究结果表明，患有缺血性心脑血管疾病和贫血或营养不良的老年患者可能具有更高的死亡率，这可能在入院时就可以预测。然而，这些发现需要进一步研究。
