Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: The CCI can be a helpful tool in predicting outcomes of patients undergoing concomitant mitral valve intervention with ascending aortic surgery.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: The CCI can be a helpful tool in predicting outcomes of patients undergoing concomitant mitral valve intervention with ascending aortic surgery.
摘要：
背景：Charlson合并症指数（CCI）被广泛用于非心脏手术患者的风险分层，然而，它尚未在接受心脏手术的患者中得到广泛验证。我们的目的是评估其预测升主动脉手术合并二尖瓣介入的早期和晚期结果的能力。
方法：回顾了1997年至2022年接受手术的患者。根据索引手术时的临床状态计算年龄调整后的CCI评分。主要终点为全因死亡率，而次要终点为主要不良事件（MAE），包括合并围手术期死亡率。透析,心肌梗塞,和中风，除了个别结果和恢复出血和气管造口术。卡方检验,Logistic和Cox回归分析，使用Kaplan-Meier曲线。使用最大选择的等级统计来确定晚期死亡率的CCI的最佳截止值。
结果：186名患者（中位年龄65[四分位距（IQR）：54-76]，69%为男性）纳入研究，中位CCI为4[IQR：3-6]。5年和10年总生存率分别为95.9%和67.1%vs59.7%，CCI≤5和>5的19.9%(P<0.001)。在多元Cox回归分析中，更高的CCI(HR1.60[1.17；2.18]，P=0.00),和较低的EF(HR0.89[0.83；0.96]，P=0.002）与晚期死亡率相关。最近一年的手术死亡率有降低的趋势（HR0.91[0.83;1.01]，P=0.070))。CCI>5的患者围手术期MAE较高(11.0%vs2.1%,P=0.017),CCI>5时，术后气管切开术和CVA的需求有更高的趋势（P=0.055）。Logistic回归显示，较高的CCI作为连续变量，与显著较高的MAE几率相关，术后透析,需要气管造口术.
结论：CCI可能是预测在升主动脉手术同时进行二尖瓣介入治疗的患者预后的有用工具。
方法：回顾了1997年至2022年接受手术的患者。根据索引手术时的临床状态计算年龄调整后的CCI评分。主要终点为全因死亡率，而次要终点为主要不良事件（MAE），包括合并围手术期死亡率。透析,心肌梗塞,和中风，除了个别结果和恢复出血和气管造口术。卡方检验,Logistic和Cox回归分析，使用Kaplan-Meier曲线。使用最大选择的等级统计来确定晚期死亡率的CCI的最佳截止值。
结果：186名患者（中位年龄65[四分位距（IQR）：54-76]，69%为男性）纳入研究，中位CCI为4[IQR：3-6]。5年和10年总生存率分别为95.9%和67.1%vs59.7%，CCI≤5和>5的19.9%(P<0.001)。在多元Cox回归分析中，更高的CCI(HR1.60[1.17；2.18]，P=0.00),和较低的EF(HR0.89[0.83；0.96]，P=0.002）与晚期死亡率相关。最近一年的手术死亡率有降低的趋势（HR0.91[0.83;1.01]，P=0.070))。CCI>5的患者围手术期MAE较高(11.0%vs2.1%,P=0.017),CCI>5时，术后气管切开术和CVA的需求有更高的趋势（P=0.055）。Logistic回归显示，较高的CCI作为连续变量，与显著较高的MAE几率相关，术后透析,需要气管造口术.
结论：CCI可能是预测在升主动脉手术同时进行二尖瓣介入治疗的患者预后的有用工具。
