中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2008年
26期
1815-1819
,共5页
吴小凡%吕树铮%陈韵岱%潘伟琪%宋现涛%李晶%刘欣%王羲之%张丽洁%任芳%骆景光
吳小凡%呂樹錚%陳韻岱%潘偉琪%宋現濤%李晶%劉訢%王羲之%張麗潔%任芳%駱景光
오소범%려수쟁%진운대%반위기%송현도%리정%류흔%왕희지%장려길%임방%락경광
心肌梗死%风险评分%血运重建
心肌梗死%風險評分%血運重建
심기경사%풍험평분%혈운중건
Myocardial infarction%Risk score%Revascularization
目的 建立中国急性冠脉综合征(ACS)患者住院不良事件的风险评分,评价血运重建对不同风险人群的疗效.方法 收集1501例中国(全球性急性冠脉事件注册研究,GRACE)研究人选患者的基线特征、诊断治疗和住院转归,通过多因素Logistic回归方法建立住院风险评分,并进行验证.以敏感度、特异度均接近70%为截点,评价血运重建对不同风险评分患者预后的影响.结果 (1)6个危险因素进入风险评分模型:包括年龄、收缩压、舒张压、心功能Killip分级、入院时心脏骤停、心电图ST段偏移;(2)拟和优度检验值为0.673,c检验为0.776;(3)将入选的1301例患者分为高风险组和低风险组(风险评分>5.5分、≤5.5分)组,血运重建明显降低ST段抬高心肌梗死患者(STEMI)[OR(95%CI)=0.32(0.11,0.94),x2=5.39,P=0.02]和非ST段抬高ACS患者(NSTEACS)[0R(95%CI)=0.32(0.06,0.94),x2=4.17,P=0.04]高风险组住院不良事件发生率,但是高风险组血运重建率均低于低风险组(STEMI:61.7%、78.3%,P=0.000;NSTEACS:42.0%、62.3%,P=0.000).结论 风险评分能够在入院早期定量预测ACS个体住院不良事件发生率,高风险组血运重建获益最大.
目的 建立中國急性冠脈綜閤徵(ACS)患者住院不良事件的風險評分,評價血運重建對不同風險人群的療效.方法 收集1501例中國(全毬性急性冠脈事件註冊研究,GRACE)研究人選患者的基線特徵、診斷治療和住院轉歸,通過多因素Logistic迴歸方法建立住院風險評分,併進行驗證.以敏感度、特異度均接近70%為截點,評價血運重建對不同風險評分患者預後的影響.結果 (1)6箇危險因素進入風險評分模型:包括年齡、收縮壓、舒張壓、心功能Killip分級、入院時心髒驟停、心電圖ST段偏移;(2)擬和優度檢驗值為0.673,c檢驗為0.776;(3)將入選的1301例患者分為高風險組和低風險組(風險評分>5.5分、≤5.5分)組,血運重建明顯降低ST段抬高心肌梗死患者(STEMI)[OR(95%CI)=0.32(0.11,0.94),x2=5.39,P=0.02]和非ST段抬高ACS患者(NSTEACS)[0R(95%CI)=0.32(0.06,0.94),x2=4.17,P=0.04]高風險組住院不良事件髮生率,但是高風險組血運重建率均低于低風險組(STEMI:61.7%、78.3%,P=0.000;NSTEACS:42.0%、62.3%,P=0.000).結論 風險評分能夠在入院早期定量預測ACS箇體住院不良事件髮生率,高風險組血運重建穫益最大.
목적 건립중국급성관맥종합정(ACS)환자주원불량사건적풍험평분,평개혈운중건대불동풍험인군적료효.방법 수집1501례중국(전구성급성관맥사건주책연구,GRACE)연구인선환자적기선특정、진단치료화주원전귀,통과다인소Logistic회귀방법건립주원풍험평분,병진행험증.이민감도、특이도균접근70%위절점,평개혈운중건대불동풍험평분환자예후적영향.결과 (1)6개위험인소진입풍험평분모형:포괄년령、수축압、서장압、심공능Killip분급、입원시심장취정、심전도ST단편이;(2)의화우도검험치위0.673,c검험위0.776;(3)장입선적1301례환자분위고풍험조화저풍험조(풍험평분>5.5분、≤5.5분)조,혈운중건명현강저ST단태고심기경사환자(STEMI)[OR(95%CI)=0.32(0.11,0.94),x2=5.39,P=0.02]화비ST단태고ACS환자(NSTEACS)[0R(95%CI)=0.32(0.06,0.94),x2=4.17,P=0.04]고풍험조주원불량사건발생솔,단시고풍험조혈운중건솔균저우저풍험조(STEMI:61.7%、78.3%,P=0.000;NSTEACS:42.0%、62.3%,P=0.000).결론 풍험평분능구재입원조기정량예측ACS개체주원불량사건발생솔,고풍험조혈운중건획익최대.
Objective To develop a simple risk score model of in-hospital major adverse cardiac events(MACE)including all-cause mortality,new or recurrent myocardial infarction(MI).and evaluate the efficacy about revascularization on patients with different risk.Methods The basic characteristics,diagnosis,therapy,and in-hospital outcomes of 1512 ACS patients from G10bal Registry of Acute Coronary Events(GRACE)study of China were collected to develop a risk score model by multivariable stepwise logistic regression.The goodness-of-fit test and discriminafive power of the final model were assessed respectively.The best cut-off value for the risk score was used to assess the impact of revascularization for ST-elevation Ml(STEMI)and non-ST elevation acute coronary artery syndrome(NSTEACS)on in-hospital outcomes.Results (1)The following 6 independent risk factors accounted for about 92.5%of the prognostic information:age≥80 years(4 points),SBP≤90 mm Hg(6 points),DBP≥90 mm Hg(2points),KiHip Ⅱ(3 points),KillipⅢorⅣ(9 points),cardiac arrest during presentation(4 points),ST-segment elevation(3 points)or depression(5 points)or combination of elevation and depression(4points)on electrocardiogram at presentation.(2)CHIEF risk model was excellent with Hosmer-Lemeshow goodness-of-fit test of 0.673 and c statistics of 0.776.(3)1301 ACS patients previously enrolled in GRACE study were divided into 2 groups with the best cut-0frvalue of 5.5 points.The impact of revascularizafion on the in-hospital MACE of the higber risk subsets was stronger than that of the lower risk subsets both in STEMI[OR(95%CI)=0.32(0.11,0.94),x2=5.39,P=0.02]and NSTEACS[OR(95%CI)=0.32(0.06,0.94),×2=4.17,P=0.04]population.However,beth STEMI(61.7%vs 78.3%,P=0.000)and NSTEACS(42.0%vs 62.3%.P=0.000)patients with the risk scores more than 5.5 points had lower revascularization mtes.Condusion The risk score provides excellent abillty to predict in-hospital death or (re)MI quantitatively and accurately.The patients undergoing revascularization with risk score greater than 5.5 have lower incidence rates of endpoint.
