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OBJECTIVE@#To develop and validate a user-friendly risk score for older mitral regurgitation (MR) patients, referred to as the Elder-MR score.@*METHODS@#The China Senile Valvular Heart Disease (China-DVD) Cohort Study functioned as the development cohort, while the China Valvular Heart Disease (China-VHD) Study was employed for external validation. We included patients aged 60 years and above receiving medical treatment for moderate or severe MR (2274 patients in the development cohort and 1929 patients in the validation cohort). Candidate predictors were chosen using Cox's proportional hazards model and stepwise selection with Akaike's information criterion.@*RESULTS@#Eight predictors were identified: age ≥ 75 years, body mass index < 20 kg/m2, NYHA class III/IV, secondary MR, anemia, estimated glomerular filtration rate < 60 mL/min per 1.73 m2, albumin < 35 g/L, and left ventricular ejection fraction < 60%. The model displayed satisfactory performance in predicting one-year mortality in both the development cohort (C-statistic = 0.73, 95% CI: 0.69-0.77, Brier score = 0.06) and the validation cohort (C-statistic = 0.73, 95% CI: 0.68-0.78, Brier score = 0.06). The Elder-MR score ranges from 0 to 15 points. At a one-year follow-up, each point increase in the Elder-MR score represents a 1.27-fold risk of death (HR = 1.27, 95% CI: 1.21-1.34, P < 0.001) in the development cohort and a 1.24-fold risk of death (HR = 1.24, 95% CI: 1.17-1.30, P < 0.001) in the validation cohort. Compared to EuroSCORE II, the Elder-MR score demonstrated superior predictive accuracy for one-year mortality in the validation cohort (C-statistic = 0.71 vs. 0.70, net reclassification improvement = 0.320, P < 0.01; integrated discrimination improvement = 0.029, P < 0.01).@*CONCLUSIONS@#The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.
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Objectives: To analyze the variations of demography, risk factors and triggering factors in acute myocardial infarction (AMI) patients in Beijing area over recent 40 years from 1970s to 2010s. Methods: Our research included in 2 groups: 1970s group, 1314 patients from Beijing collaborative group of coronary artery disease prevention and treatment from 1972-01 to 1973-12; 2010s group, 2200 patients from China AMI registry in Beijing area from 2013-01-01 to 2014-09-30. Demographic characteristics including gender, age, farmer proportion, risk factors and triggering factors for AMI occurrence were compared between 2 groups. Results: Compared with 1970s group, 2010s group had more patients>70 years of age (15.8% vs 25.6%, P<0.001), more with male gender (68.3% vs 75.6%, P<0.001) and the higher farmer proportion (6.5% vs 14.5%, P<0.001); 2010s group showed more patients with previous histories of stroke (6.2% vs 10.5%), MI (9.5% vs 11.9%) and diabetes mellitus (DM) (6.2% vs 27.6%), all P<0.05; 2010s group presented that less patients were triggered by mental stress (51.1% vs 15.2%, P<0.001), while more were induced by physical stress (40.0% vs 61.1%, P=0.007). Conclusions: There were significant changes in recent 40 years for AMI patients in terms of age, gender, farmer proportion, previous histories of stroke, MI and DM; it appeared as aging, androphany and ruralized trends. Physical stress and unhealthy lifestyle were the major triggering factors for AMI occurrence nowadays, more specific efforts should be conducted for heart disease prevention and education.