Coronary artery bypass grafting in octogenarians: a nomogram for predicting all-cause mortality.

IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiothoracic Surgery Pub Date : 2024-10-03 DOI:10.1186/s13019-024-03054-6
Saeed Davoodi, Mohammad Sadeq Najafi, Ahmad Vakili-Basir, Arash Jalali, Zahra Karimi, Elnaz Shahmohamadi, Mohadese Dashtkoohi, Aryan Ayati, Alireza Hadizadeh, Shahram Momtahan, Mahmoud Shirzad, Jamshid Bagheri
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Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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八旬老人的冠状动脉旁路移植术:预测全因死亡率的提名图。
背景:八旬老人接受冠状动脉旁路移植术(CABG)的益处和风险仍不明确。本研究旨在确定八旬老人接受冠状动脉旁路移植术后全因死亡风险增加的预测因素:我们回顾性分析了2007年至2016年间接受孤立选择性泵上CABG的1636名八旬老人的数据。主要终点是任何原因导致的死亡率。死亡率采用 Kaplan-Meier 曲线。对术前和手术变量进行了单变量 Cox 回归。采用柯克斯比例危险模型的阿凯克信息准则(AIC)来确定最强的预测因子。我们根据所选变量设计了一个提名图,以计算一年、五年和十年后的死亡风险。我们根据 C 指数进行了引导重采样,以验证最终模型。在不同的时间点绘制了校准图:患者的平均年龄为 82.03 岁(SD = 1.74),74% 为男性。在中位 9.2(95% CI 9.0,9.5)年的随访中,626 名(38.2%)患者死亡。根据 AIC 筛选出最佳预测因子后,多变量 Cox 回归结果显示,射血分数是预测死亡的关键因素:接受 CABG 手术的八旬老人有很高的死亡风险,这受到术前和手术风险因素的影响。建议的提名图可用于优化对这一脆弱年龄组的管理。临床注册号:IR.TUMS.THC.REC.1400.081。
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来源期刊
Journal of Cardiothoracic Surgery
Journal of Cardiothoracic Surgery 医学-心血管系统
CiteScore
2.50
自引率
6.20%
发文量
286
审稿时长
4-8 weeks
期刊介绍: Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.
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