Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
J Cardiothorac Surg. 2024 Oct 3;19(1):586. doi: 10.1186/s13019-024-03054-6.
The benefits and risks of coronary artery bypass grafting (CABG) in octogenarians remain unclear. This study aimed to identify the predictors of increased risk of all-cause mortality in octogenarian patients after CABG.
We retrospectively analyzed the data of 1636 octogenarians who underwent isolated elective on-pump CABG between 2007 and 2016. The primary endpoint was mortality from any cause. The Kaplan-Meier curve was generated for mortality. A univariate Cox regression was performed for preprocedural and procedural variables. The Akaike information criterion (AIC) using the Cox proportional hazard model was applied to determine the strongest predictors. We designed a nomogram based on the selected variables to calculate the mortality risk after one, five, and ten years. The bootstrap resampling based on the C-index was performed to validate the final model. Calibration plots were created at different time points.
The mean age of the patients was 82.03 years (SD = 1.74), and 74% were male. In a median follow-up of 9.2 (95% CI 9.0,9.5) years, 626 (38.2%) patients died. After the selection of best predictors based on AIC, the multivariable Cox regression showed that ejection fraction < 40 (HR 1.41, 95% CI 1.21-1.65, P < 0.001), two-vessel disease (HR: 0.59, 95% CI 0.40-0.89, P = 0.012), peripheral vascular disease (HR 1.52, 95% CI 1.05-2.21, P = 0.027), and valvular heart disease (HR 1.45, 95% CI 1.24-1.69, P < 0.001) were the significant predictors of all-cause mortality.
Octogenarians who undergo CABG have a high mortality risk, influenced by several preprocedural and procedural risk factors. The proposed nomogram can be considered for optimizing the management of this vulnerable age group. Clinical registration number IR.TUMS.THC.REC.1400.081.
80 岁以上人群行冠状动脉旁路移植术（CABG）的获益和风险仍不明确。本研究旨在确定影响 80 岁以上患者 CABG 后全因死亡率增加的预测因素。
我们回顾性分析了 2007 年至 2016 年间 1636 例 80 岁以上行择期体外循环 CABG 的患者数据。主要终点为任何原因导致的死亡率。通过 Kaplan-Meier 曲线计算死亡率。采用单变量 Cox 回归分析术前和术中变量。应用 Cox 比例风险模型的赤池信息量准则（AIC）确定最强预测因素。我们根据选定变量设计了一个列线图来计算 1、5 和 10 年后的死亡率风险。基于 C 指数的 bootstrap 重采样用于验证最终模型。在不同时间点绘制校准图。
患者的平均年龄为 82.03 岁（SD=1.74），74%为男性。中位随访 9.2 年（95%CI 9.0，9.5）期间，626 例（38.2%）患者死亡。根据 AIC 选择最佳预测因素后，多变量 Cox 回归显示射血分数<40（HR 1.41，95%CI 1.21-1.65，P<0.001）、双支血管疾病（HR：0.59，95%CI 0.40-0.89，P=0.012）、外周血管疾病（HR 1.52，95%CI 1.05-2.21，P=0.027）和瓣膜性心脏病（HR 1.45，95%CI 1.24-1.69，P<0.001）是全因死亡率的显著预测因素。
行 CABG 的 80 岁以上患者死亡率较高，受多种术前和术中危险因素影响。所提出的列线图可用于优化该脆弱年龄组的管理。临床注册号 IR.TUMS.THC.REC.1400.081。
