KAMIR和TIMI危险评分预测ST段抬高型心肌梗死预后的价值

The prognostic significance of risk scores for predicting ST-segment elevation myocardial infarction:KAMIR and TIMI scales compared

目的：比较KAMIR与TIMI危险评分对ST段抬高型心肌梗死（STEMI）患者1年预后的评估价值.方法：回顾性分析2010年1-12月广州医科大学第二附属医院收治的111例STEMI患者的临床资料,分析1年死亡率与KAMIR/TIMI危险评分分值的相关性;根据ROC曲线下面积比较KAMIR与TIMI危险评分对患者1年死亡率预测的准确度.结果：出院后1年病死率为19.8%.生存患者与病死患者年龄、高血压史、糖尿病史,就诊时血糖升高等比较,差异有统计学意义（P＆lt;0.05）.KAMIR危险评分值与STEMI患者1年死亡率呈正相关性（P＆lt;0.05）.KAMIR危险评分对STEMI1年病死率预测的ROC曲线灵敏度为68.18%（95%CI 45.1~86.1）,特异度为68.54%（95%CI 57.8~78.0）.TIMI危险评分ROC曲线的灵敏度为36.36%（95%CI 17.2~59.3）,特异度为79.78%（95%CI 68.7~86.6）.KAMIR危险评分对预测STEMI患者1年病死率的ROC曲线下面积大于TIMI危险评分（AUC 0.728 vs.0.614,P=0.036）.结论：KAMIR危险评分比TIMI危险评分对STEMI患者1年病死率预测的准确度更高.

Objective： To compare the significance of KAMIR and TIMI risk scores for predicting the annual mortality of ST-segment elevation myocardial infarction （STEMI）. Methods： We did a retrospective analysis on the clinical data derived from 111 patients with STEMI who were admitted to The Second Affiliated Hospital of Guangzhou Medical University between Januaryand December 2010. This was followed by analysis on the correlation between KAMIR and TIMI risk scoreassessed and the annual mortality rate, whose assay accuracy was compared by using receiver operation characteristic curves. Results： The annual mortality rate after discharge was 19.8%. There was a significant difference in the age, history of hypertension, diabetes and admission blood glucose levels between survivors and those who succumbed （ all P 〈 0.05 ）. The KAMIR score for STEMI was positively correlated with to the annual mortality rate. The assay sensitivity was 68.18% （95% CI： 45.1 -86.1 ） and 36.36% （95% CI： 17.2 -59.3）, and the specificity was 68.54% （95% CI： 57.8 -78.0） and 79.78% （95% CI： 68.7- 86.6） for KAMIR and STEMI score, respectively. Furthermore, the KAMIR score yielded a higher area under curve for receiver operation characteristic curve than the TIMI score （ AUC ： 0.728 vs. 0. 614,P = 0. 036）. Conclusion ： The KAMIR score has a better predictive value of the annual mortality rate compared with the TIMI risk score in patients with ST-segment elevation myocardial infarction.