入院修正休克指数对ST段抬高型心肌梗死患者短期预后的预测价值
发布时间：2019-06-24 12:10
【摘要】：目的:本研究旨在探讨修正休克指数对急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)患者直接经皮冠状动脉支架置入(percutaneous coronary intervention,PCI)术后短期主要不良心血管事件(major adverse cardiovascular events,MACE)危险的预测价值。方法:共纳入2013年09月至2015年02月于南昌大学第二附属医院心血管内科行直接PCI术的STEMI患者263例,记录其临床基本资料,计算休克指数(shock index,SI)、修正休克指数(modified shock index,MSI)和心肌梗死溶栓治疗临床试验(thrombolysis in myocardial infarction,TIMI)危险评分值。根据受试者操作特征曲线((receiver operator characteristic curve,ROC)曲线下面积(area under the curve,AUC)对比3种评分系统对STEMI患者7天内全因死亡、致命性心律失常、心源性休克、再发心肌梗死等MACE发生的预测能力,并根据MSI的诊断界值将患者分为高MSI组及低MSI组,比较两组间7天及30天MACE发生情况。根据多因素logistic回归分析筛选出STEMI患者7天MACE发生的独立危险因素。结果:1、本研究共纳入了263例行直接PCI的STEMI患者,年龄为37-88岁,其中男性220例。STEMI患者7天MACE发生组中TIMI、SI及MSI分值均高于无MACE生存组(P0.05)。3种评分预测STEMI患者7天MACE发生的AUC均0.7,且分辨准确度无显著差异(P0.05)。2、由ROC曲线分析得出MSI预测STEMI患者7天MACE发生的诊断界值是1.3(AUC=0.718,95%CI为0.638-0.797,P0.01)。根据界值分为低MSI组(174例)和高MSI组(89例),其中高MSI组年龄更大(63.1±12.8 vs 68.7±13.5,P0.01),余指标未见差异。7天随访过程中MACE发生48例,其中高MSI组MACE发生率更高(37.1%vs 7.6%,P0.5)。30天随访过程中MACE发生59例,高MSI组MACE发生率更高(37.1%vs 7.6%,P0.5)。3、7天内无MACE发生组与MACE组之间具有统计学差异的因素分别为年龄(62.8±12.8 vs 74.8±10.7,P0.01)、高血压史(40.3%vs 56.8%,P0.05)、收缩压(120.7±25.2 vs 111.7±19.2,P0.05)、舒张压(74.5±14.8 vs 70.2±14.5,P0.05)、心率(80.2±16.4 vs 93.1±23.9,P0.01)、Killip分级≥II级(8.7%vs41.7%,P0.05)、MSI分值(1.07±0.24 vs 1.36±0.26,P0.01)。4、多因素logistic回归分析结果显示:STEMI患者7天MACE发生的独立危险因素为年龄(OR值=1.07,95%CI为1.032-1.121,P0.01)、血糖(OR值=1.217,95%CI为1.081-1.370,P0.05)、MSI得分(OR值=3.615,95%CI为1.213-10.667,P0.05)。并且MSI得分与年龄呈弱相关(r=0.223,P0.01),与血糖无明显相关(P0.05)。结论:TIMI、SI及MSI评分系统对预测STEMI患者直接PCI术后短期MACE发生都有较高的价值,而MSI评分可以更简单可靠地预测STEMI患者的短期预后。
[Abstract]:Objective: to evaluate the value of modified shock index in predicting the risk of short-term major adverse cardiovascular events (major adverse cardiovascular events,MACE) in patients with acute ST segment elevation myocardial infarction (acute ST-segment elevation myocardial infarction,STEMI) after direct percutaneous coronary artery stent implantation (percutaneous coronary intervention,PCI). Methods: from September 2013 to February 2015, 263 patients with STEMI underwent direct PCI operation in the Department of Cardiovascular Medicine, the second affiliated Hospital of Nanchang University. The basic clinical data were recorded. The shock index (shock index,SI), modified shock index (modified shock index,MSI) and clinical trial (thrombolysis in myocardial infarction,TIMI of myocardial infarction were calculated. According to the area under the operating characteristic curve (receiver operator characteristic curve,ROC (area under the curve,AUC), the predictive ability of the three scoring systems for the occurrence of MACE in STEMI patients within 7 days was compared. According to the diagnostic threshold of MSI, the patients were divided into high MSI group and low MSI group, and the occurrence of MACE in 7 and 30 days between the two groups was compared. According to multivariate logistic regression analysis, the independent risk factors of MACE in STEMI patients at 7 days were selected. Results: 1. A total of 263 STEMI patients with direct PCI were enrolled in this study, of whom 220 were males. The scores of TIMI,SI and MSI in the 7-day MACE group were higher than those in the non-MACE survival group (P 0.05). All the three scores predicted the AUC occurrence of MACE in STEMI patients on the 7th day, and there was no significant difference in the resolution accuracy (P 0.05). According to ROC curve analysis, the diagnostic threshold of MSI in predicting the occurrence of MACE in STEMI patients on the 7th day was 1.3 (AUC=0.718,95%CI was 0.638 卤0.797, P01). According to the boundary value, the patients were divided into low MSI group (n = 174) and high MSI group (n = 89). The age of high MSI group was 63.1 卤12.8 vs 68.7 卤13.5, and there was no difference in the rest indexes. 48 cases of MACE occurred during 7 days follow-up, among which the incidence of MACE in high MSI group was higher (37.1%vs 7.6%, P0.5). 59 cases of MACE occurred during 30 days follow-up, and the incidence of MACE in high MSI group was higher (37.1%vs 7.6%). P0.5). 3The factors of age (62.8 卤12.8 vs 74.8 卤10.7, P 0.01), hypertension history (40.3%vs 56.8%, P 0.05), systolic blood pressure (120.7 卤25.2 vs 111.7 卤19.2, P 0.05), diastolic blood pressure (74.5 卤14.8 vs 70.2 卤14.5, P 0.05), heart rate (80.2 卤16.4 vs 93.1 卤23.9, P 0.05), diastolic blood pressure (74.5 卤14.8 vs 70.2 卤14.5), heart rate (80.2 卤16.4 vs 93.1 卤23.9, P < 0.05), diastolic blood pressure (74.5 卤14.8 vs 70.2 卤14.5, P 0.05), heart rate (80.2 卤16.4 vs 93.1 卤23.9, respectively) P01), Killip grade 鈮，
本文编号：2505051
[Abstract]:Objective: to evaluate the value of modified shock index in predicting the risk of short-term major adverse cardiovascular events (major adverse cardiovascular events,MACE) in patients with acute ST segment elevation myocardial infarction (acute ST-segment elevation myocardial infarction,STEMI) after direct percutaneous coronary artery stent implantation (percutaneous coronary intervention,PCI). Methods: from September 2013 to February 2015, 263 patients with STEMI underwent direct PCI operation in the Department of Cardiovascular Medicine, the second affiliated Hospital of Nanchang University. The basic clinical data were recorded. The shock index (shock index,SI), modified shock index (modified shock index,MSI) and clinical trial (thrombolysis in myocardial infarction,TIMI of myocardial infarction were calculated. According to the area under the operating characteristic curve (receiver operator characteristic curve,ROC (area under the curve,AUC), the predictive ability of the three scoring systems for the occurrence of MACE in STEMI patients within 7 days was compared. According to the diagnostic threshold of MSI, the patients were divided into high MSI group and low MSI group, and the occurrence of MACE in 7 and 30 days between the two groups was compared. According to multivariate logistic regression analysis, the independent risk factors of MACE in STEMI patients at 7 days were selected. Results: 1. A total of 263 STEMI patients with direct PCI were enrolled in this study, of whom 220 were males. The scores of TIMI,SI and MSI in the 7-day MACE group were higher than those in the non-MACE survival group (P 0.05). All the three scores predicted the AUC occurrence of MACE in STEMI patients on the 7th day, and there was no significant difference in the resolution accuracy (P 0.05). According to ROC curve analysis, the diagnostic threshold of MSI in predicting the occurrence of MACE in STEMI patients on the 7th day was 1.3 (AUC=0.718,95%CI was 0.638 卤0.797, P01). According to the boundary value, the patients were divided into low MSI group (n = 174) and high MSI group (n = 89). The age of high MSI group was 63.1 卤12.8 vs 68.7 卤13.5, and there was no difference in the rest indexes. 48 cases of MACE occurred during 7 days follow-up, among which the incidence of MACE in high MSI group was higher (37.1%vs 7.6%, P0.5). 59 cases of MACE occurred during 30 days follow-up, and the incidence of MACE in high MSI group was higher (37.1%vs 7.6%). P0.5). 3The factors of age (62.8 卤12.8 vs 74.8 卤10.7, P 0.01), hypertension history (40.3%vs 56.8%, P 0.05), systolic blood pressure (120.7 卤25.2 vs 111.7 卤19.2, P 0.05), diastolic blood pressure (74.5 卤14.8 vs 70.2 卤14.5, P 0.05), heart rate (80.2 卤16.4 vs 93.1 卤23.9, P 0.05), diastolic blood pressure (74.5 卤14.8 vs 70.2 卤14.5), heart rate (80.2 卤16.4 vs 93.1 卤23.9, P < 0.05), diastolic blood pressure (74.5 卤14.8 vs 70.2 卤14.5, P 0.05), heart rate (80.2 卤16.4 vs 93.1 卤23.9, respectively) P01), Killip grade 鈮，
本文编号：2505051
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