Nishibe Toshiya, Kano Masaki, Akiyama Shinobu, Iwahashi Toru, Fukuda Shoji
Department of Medical Informatics and Management, Hokkaido Information University, Ebetsu, Hokkaido, Japan.
Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2025;31(1). doi: 10.5761/atcs.oa.24-00185.
Our primary concern was the risk of overtreating elderly patients with endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. We investigated the association between age at the time of EVAR and all-cause mortality in Japan's aging population by stratifying patients into age groups.
Data from 175 patients who underwent elective EVAR from 2012 to 2016 were analyzed. Patients were categorized into 3 age groups: <75 years, 75-84 years, and ≥85 years, based on Japan's healthy life expectancy and average life expectancy. Survival rates and risk factors for mortality were assessed across these patient groups.
Among 175 patients, 3- and 5-year survival rates were significantly lower in elderly patients, with rates of 74.6% and 64.2% for those aged 75-84 years and 51.9% and 39.7% for those aged ≥85 years. Multivariate analysis identified age ≥85 years, chronic kidney disease, chronic obstructive pulmonary disease, and active cancer as independent adverse predictors of all-cause mortality, whereas obesity was identified as an independent protective predictor.
Adjusting guidelines to incorporate not only comorbidities but also age could optimize outcomes and healthcare resource allocation by prioritizing EVAR for patients most likely to benefit in Japan's super-aging society.
我们主要关注的是对老年腹主动脉瘤患者进行血管内动脉瘤修复术（EVAR）过度治疗的风险。我们通过将患者分层为不同年龄组，研究了日本老年人群中EVAR时的年龄与全因死亡率之间的关联。
分析了2012年至2016年期间接受择期EVAR的175例患者的数据。根据日本的健康预期寿命和平均预期寿命，将患者分为3个年龄组：<75岁、75 - 84岁和≥85岁。评估了这些患者组的生存率和死亡风险因素。
在175例患者中，老年患者的3年和5年生存率显著较低，75 - 84岁患者的生存率分别为74.6%和64.2%，≥85岁患者的生存率分别为51.9%和39.7%。多变量分析确定年龄≥85岁、慢性肾脏病、慢性阻塞性肺疾病和活动性癌症是全因死亡率的独立不良预测因素，而肥胖是独立的保护性预测因素。
调整指南，不仅纳入合并症，还纳入年龄，通过在日本超老龄化社会中优先为最可能受益的患者进行EVAR，可优化治疗结果和医疗资源分配。
