溶栓危险评分对急性心肌梗塞再灌注治疗患者的预后评价

Predictive value of thrombolysis in myocardial infarction risk score in patients with ST-elevation myocardial infarction received reperfusion therapy

目的:探讨心肌梗塞溶栓治疗(TIMI)危险评分对接受再灌注治疗的ST段抬高心肌梗塞(STEMI)患者院内死亡的预测价值,能否在入院时筛选出急诊经皮冠状动脉介入(PCI)术获益更大的高危患者。方法:应用TIMI危险评分对267例接受再灌注治疗的STEMI患者进行危险分层,分为低危组(TIMI评分0-4分)及高危组(TIMI评分≥5分),比较两组患者接受急诊PCI与溶栓治疗对院内死亡率的影响。结果:TIMI评分高危组院内死亡率显著高于低危组(14.4%:2.8%,P=0.001),其中接受急诊PCI治疗的患者死亡率显著低于溶栓治疗的(9.2%:26.3%,P=0.012)。而低危组患者接受急诊PCI术与溶栓治疗则死亡率无显著差异(2.2%:3.9%,P=0.618)。结论:TIMI危险评分可作为简便易行的方法评估再灌注治疗STEMI患者的预后,并有助于选择再灌注治疗方案。

Objective： To evaluate the prognostic value of thrombolysis in myocardial infarction （TIMI） risk score in patients with ST-elevation myocardial infarction （STEMI） received reperfusion therapy. Methods： The 267 patients with STEMI were divided into low risk group （TIMI risk score of 0-4 ） or high risk group （TIMI risk score of ≥5） according TIMI risk score, and investigated the effect of primary percutaneous coronary intervention （PCI） versus thrombolysis on mortality in the two groups. Results： In-hospital mortality was significant higher in the high-risk group than that in the low-risk group （14. 4% ： 2.8%, P=0. 001）. In high-risk patients there was a significant reduction of mortality in primary PCI group than that in thrombolysis group （9.2% ： 26.3%, P=0. 012）. However in the low-risk group, there was no significant difference in mortality between primary PCI group and thrombolysis group （2. 2% ： 3.9%, P=0.618）. Conclusion： The TIMI risk score can be easily applied for risk stratification at admission in patients with STEMI, and be beneficial in deciding reperfusion strategy.