摘要
目的探讨休克指数(shock index,SI)在急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者院内死亡预测中的价值。方法STEMI患者1 686例,均测量入院时收缩压、心率,计算SI,绘制ROC曲线评估SI预测STEMI院内死亡的效能;将1 686例患者根据SI最佳截断值分为低SI组(SI<0.682)1218例和高SI组(SI≥0.682)468例,比较2组一般资料、临床特征、治疗及预后情况,广义混合效应模型回归分析SI与STEMI患者院内死亡的关系。结果ROC曲线分析显示,SI以0.682为最佳截断值,预测STEMI患者院内死亡的AUC为0.729(95%CI:0.671~0.788,P<0.001),灵敏度为67.7%,特异度为74.2%;高SI组中位年龄(66.43岁)较低SI组(63.30岁)大,女性(31.41%)及入院时前壁心肌梗死(65.17%)、合并心律失常(28.21%)、心功能Killip分级2~4级(49.57%)、心率>100次/min(30.13%)、收缩压<90mm Hg(8.33%)、使用β受体阻滞剂治疗比率(63.68%)及院内病死率(13.25%)均高于低SI组(25.86%、53.12%、15.11%、31.69%、2.30%、0.99%、57.55%、2.71%),有高血压史(38.68%)、发病12h内接受再灌注治疗(33.55%)及使用阿司匹林(95.51%)、氯吡格雷(89.10%)、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂(43.59%)、替罗非班治疗比率(5.98%)低于低SI组(49.92%、40.80%、97.37%、92.36%、51.89%、9.20%)(P<0.05);多因素广义混合效应模型回归分析结果显示,SI≥0.682(OR=4.02,95%CI:2.33~6.94,P<0.001)是STEMI患者院内死亡的危险因素。结论SI在预测STEMI患者院内死亡中具有较高的价值,SI≥0.682者院内死亡风险明显增高。
Objective To investigate the value of shock index(SI)to predicting in-hospital death in patients with acute ST-elevation myocardial infarction(STEMI).Methods Totally 1 688STEMI patients were measured systolic blood pressure and heart rate at admission to calculate the SI.ROC was drawn to assess the efficiency of SI on predicting in-hospital death in STEMI patients.According to the optimal cut-off value,1 688patients were divided into 1 218 patients with SI<0.682(low-SI group)and 468patients with SI≥0.682(high-SI group).The general data,clinical features,treatment and prognosis were compared between two groups.Generalized linear mixed model was adopted to analyze the relationship between SI and in-hospital death.Results When the optimal cut-offof SI was 0.682,the AUC for in-hospital death was 0.729(95%CI:0.671-0.788,P<0.001),the sensitivity was 67.7%and the specificity was 74.2%.High-SI group had older median age(66.43years),higher percentages of females,anterior myocardial infarction,arrhythmia,Killip class 2-4,heart rate>100beat/min,systolic blood pressure<90mm Hg andβ-blocker application at admission(31.41%,65.17%,28.21%,49.57%,30.13%,8.33%,63.65%),higher in-hospital fatality(13.25%),and lower percentages of hypertension,early reperfusion in 12has well as applications of aspirin,clopidogrel,angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and tirofiban(38.68%,33.55%,95.51%,89.10%,43.59%,5.98%)significantly than those in low-SI group(63.30years,25.86%,53.12%,15.11%,31.69%,2.30%,0.99%,57.55%,2.71%,49.92%,40.80%,97.37%,92.36%,51.89%,9.20%)(P<0.05).Generalized linear mixed analysis indicated that SI≥0.682(OR=4.02,95%CI:2.33-6.94,P<0.001)was a risk factor for in-hospital death of STEMI patients.Conclusion SI has a high value to predicting the risk factors for in-hospital death of STEMI patients,and those with SI≥0.682have a higher risk for in-hospital death.
作者
王山
张优
高传玉
戴国友
刘馨允
程倩倩
胡大一
WANG Shan;ZHANG You;GAO Chuanyu;DAI Guoyou;LIU Xinyun;CHENG Qianqian;HU Dayi(Heart Center of Henan Provincial People’s Hospital,Department of Cardiology of People’s Hospital of Zhengzhou University,Henan Key Laboratory of Coronary Heart Disease Control of Central China Fuwai Hospital,Henan Research Center for Cardiovascular Epidemiology,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou450003,China;Department of Cardiology,Peking University People’s Hospital,Beijing100044,China)
出处
《中华实用诊断与治疗杂志》
2019年第9期849-852,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划项目(201602210)
河南省科技厅重点攻关项目(132102310080)
关键词
急性ST段抬高型心肌梗死
休克指数
院内死亡
acute ST-segment elevation myocardial infarction
shock index
in-hospital death
