Department of Cardiothoracic Surgery, Weill Cornell Medicine / New York-Presbyterian Hospital, New York, NY, United States of America.
Department of Cardiothoracic Surgery, Weill Cornell Medicine / New York-Presbyterian Hospital, New York, NY, United States of America; National Cancer Institute, Cairo University, Egypt.
Int J Cardiol. 2024 Oct 15;413:132398. doi: 10.1016/j.ijcard.2024.132398. Epub 2024 Jul 26.
The Charlson Comorbidity Index (CCI) is widely utilized for risk stratification for non-cardiac surgical patients, yet it has not been broadly validated in patients undergoing cardiac surgery. We aim to assess its ability to predict early and late outcomes of concomitant mitral valve intervention with ascending aortic surgery.
Patients who underwent surgery between 1997 and 2022 were reviewed. Age-adjusted CCI scores were calculated based on clinical status at a time of index operation. The primary endpoint was all causes mortality while secondary outcomes were major adverse events (MAE) that included combined perioperative mortality, dialysis, myocardial infarction, and stroke in addition to the individual outcomes and take back for bleeding and tracheostomy. Chi-square test, Logistic and Cox regression analysis, and Kaplan-Meier curves were used. Maximally selected rank statistics were used to identify best cutoff of CCI for late mortality.
186 patients (median age 65 [interquartile range (IQR): 54-76] and 69% males) were included with a median CCI of 4 [IQR: 3-6]. Five and ten-years overall survival were 95.9% and 67.1% vs 59.7%, and 19.9% in CCI ≤ 5 vs >5 (P < 0.001). On multivariate Cox regression analysis, higher CCI (HR 1.60 [1.17;2.18], P = 0.00), and lower EF (HR 0.89 [0.83;0.96], P = 0.002) were associated with late mortality. There was a trend to lower mortality in recent surgery years (HR 0.91 [0.83;1.01], P = 0.070)). Perioperative MAE was higher in CCI >5 (11.0% vs 2.1%, P = 0.017), and postoperative need for tracheostomy and CVA had a trend to be higher in CCI > 5 (P = 0.055). Logistic regression revealed that higher CCI, as a continuous variable, was associated with significantly higher odds of MAE, postoperative dialysis, and need for tracheostomy.
The CCI can be a helpful tool in predicting outcomes of patients undergoing concomitant mitral valve intervention with ascending aortic surgery.
Charlson 合并症指数（CCI）广泛用于非心脏手术患者的风险分层，但尚未在接受心脏手术的患者中广泛验证。我们旨在评估其预测同期二尖瓣介入术与升主动脉手术早期和晚期结果的能力。
回顾了 1997 年至 2022 年期间接受手术的患者。根据指数手术时的临床状况计算年龄调整的 CCI 评分。主要终点是全因死亡率，次要终点是主要不良事件（MAE），包括围手术期死亡率、透析、心肌梗死和中风，以及单独的结局和出血及气管切开术的再次治疗。使用卡方检验、Logistic 和 Cox 回归分析以及 Kaplan-Meier 曲线。最大选择秩统计用于确定 CCI 对晚期死亡率的最佳截断值。
纳入 186 例患者（中位数年龄 65 岁[四分位距（IQR）：54-76]，69%为男性），CCI 中位数为 4 分[IQR：3-6]。5 年和 10 年总生存率分别为 95.9%和 67.1%与 59.7%和 19.9%，CCI≤5 与>5（P<0.001）。多变量 Cox 回归分析显示，CCI 较高（HR 1.60[1.17;2.18]，P=0.00）和 EF 较低（HR 0.89[0.83;0.96]，P=0.002）与晚期死亡率相关。最近手术年份的死亡率呈下降趋势（HR 0.91[0.83;1.01]，P=0.070）。CCI>5 的患者围手术期 MAE 更高（11.0%与 2.1%，P=0.017），CCI>5 的患者术后需要气管切开术和 CVA 有升高的趋势（P=0.055）。Logistic 回归显示，CCI 作为连续变量，与 MAE、术后透析和气管切开术的需求显著更高的可能性相关。
CCI 可作为预测同期二尖瓣介入术与升主动脉手术患者结局的有用工具。
