CADILLAC和TIMI危险积分对AMI病人病情评估价值的比较研究

Comparison study of value of severity evaluation between CADILLAC and TIMI risk scores to patients with AMI

目的对比研究TIMI和CADILLAC危险积分对急性心肌梗死(AMI)病人病情评估的价值。方法回顾性分析86例AMI病人的临床资料并分别进行TIMI和CADILLAC危险积分评分,比较两种评分方法不同分数段病死率、主要心脏事件(MACE)发生率的差异,比较TIMI和CADILLAC危险积分对病人病死率、MACE发生率预测的效准度和分辨度的差异。结果AMI病人的TIMI和CADILLAC危险积分在不同分数段(0-2;3-5;≥6分)、不同时间点(14d和30d)内,病死率和MACE发生率有显著性差异(P<0.05);CADILLAC危险积分对应的hosmer-lemeshow拟合优度检验P值明显优于TIMI危险积分,与病人实际病死率更接近,而且CADILLAC对应的AUROCC也明显高于TIMI。对于病人发生AMI14d和30d分别进行比较,在第14天内,TIMI和CADILLAC危险积分对病人病情预测的ROC曲线下面积和hosmer-lemeshow拟合优度检验的P值基本接近,而30d的时间内,则CADILLAC危险积分明显优于TIMI。结论CADILLAC危险积分比TIMI危险积分对AMI病人的病情评估更准确,应该作为一种新的简单、可靠、实用的AMI患者病死危险性预测评分方法在临床推广应用。

[Objective] To compare the value of severity evaluation of patients with acute myocardial infarction （AMI） between CADILLAC and TIMI risk score. [Methods] Data of 86 patients with AMI were gleaned, analyzed and scored with CADILLAC and TIMI risk scores respectively. Difference of mortality and morbidity of MACE among the different score segments were compared in CADILLAC and TIMI risk score respectively. Difference of Calibration and Discrimination of CADILLAC and TIMI risk scores for mortality and morbidity of MACE of patients were compared respectively too. [Results] There had significant difference in mortality and morbidity of MACE among the different score segments（0-2; 3-5; ≥6 score）and different time points （the 14 day; the 30 day） of CADIL- LAC and TIMI risk scores for AMI patients （P 〈0.05）. Value of P for hosmer-lemeshow of CADILLAC risk score in mortality of AMI patients was superior to that of TIMI risk score. The mortality predicted with CADILLAC risk score was more closely to actual mortality than that of TIMI risk score. AUROCC of CADILLAC risk score in mortality of AMI patients was higher than that of TIMI risk score too. In the 14 day point of patients in hosptial, Value of P for hosmer-lemeshow and AUROCC for severity evaluation to AMI patients were proximity between CADILLAC and TIMI risk scores, but CADILLAC risk score was superior to that of TIMI risk score in the 30 day point. [Conclusion] CADILLAC risk score was superior to TIMI risk score in evaluating severity and predicting outcome of AMI patients.