[BMJ Open] Value of pulmonary artery pressure in predicting in-hospital and one-year mortality after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease: an observational study [肺动脉高压是风心病患者外科换瓣术后住院及一年死亡率的预测因素]

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Authors
Lei Jiang, Xue-biao Wei, Peng-cheng He, Du Feng, Yuan-hui Liu, Jin Liu, Ji-yan Chen, Dan-qing Yu, Ning Tan

Abstract
Objectives To investigate the role of pulmonary artery pressure (PAP) in predicting in-hospital death after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease.

Design An observational study.

Setting Guangdong General Hospital, China.

Participants 1639middle-aged and aged patients (mean age 57±6 years) diagnosed with rheumatic mitral disease, undergoing valve replacement surgery and receiving coronary angiography and transthoracic echocardiography before operation, were enrolled.

Interventions All participants underwent valve replacement surgery and received coronary angiography before operation.

Primary and secondary outcome measures In-hospital death and 1-year mortality after operation.

Methods Included patients were divided into four groups based on the preoperative PAP obtained by echocardiography: group A (PAP≤30 mm Hg); group B (>30 mm Hg<PAP≤50 mm Hg), group C (>50 mm Hg<PAP≤70 mm Hg) and group D (PAP>70 mm Hg). The relationship between PAP and in-hospital death and cumulative rate of 1-year mortality was evaluated.

Results In-hospital mortality rate increased gradually but significantly as the PAP level increased, with 1.9% in group A (n=268), 2.3% in group B (n=771), 4.7% in group C (n=384) and 10.2% in group D (n=216) (p<0.001). Multivariate analysis showed that PAP>70 mm Hg was an independent predictor of in-hospital death (OR=2.93, 95% CI 1.61 to 5.32, p<0.001). PAP>52.5 mm Hg had a sensitivity of 60.3% and specificity of 67.7% in predicting in-hospital death (area under the curve=0.672, 95% CI 0.602 to 0.743, p<0.001). Kaplan–Meier analysis showed that patients with PAP>52.5 mm Hg had higher 1-year mortality after operation than those without (log-rank=21.51, p<0.001).

Conclusions PAP could serve as a predictor of postoperative in-hospital and 1-year mortality after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease.