摘要
目的探讨ACEF评分对年龄≥75岁急性ST段抬高型心肌梗死(STEMI)患者直接PCI短期临床获益的价值。方法连续收集2011年11月~2014年1月在阜外医院心内科住院的STEMI并行直接PCI患者104例,依据患者入院时ACEF评分分为低中危组18例,ACEF评分0.97~1.27(1.18±0.09)分,高危组86例,ACEF评分1.28~4.30(1.63±0.05)分。主要结局是30d全因病死率和1年全因病死率。单因素Cox回归模型分析低中危组和高危组与结局的相关性。通过ROC曲线评价ACEF评分系统预测30d及1年病死率。结果低中危组脑梗死、LVEF明显高于高危组[33.3%vs 8.1%,P=0.003;(64.8±6.3)%vs(50.8±8.6)%,P=0.001],年龄、身高、男性[(76.1±1.9)岁vs(78.3±3.6)岁,P=0.001;(1.6±0.1)mvs(1.7±0.1)m,P=0.048;38.9%vs67.4%,P=0.023]明显低于高危组。ACEF评分系统预测30d病死率和1年病死率的ROC曲线下面积分别是0.669和0.680。单因素Cox回归分析显示,高危组30d和1年死亡风险与低中危组无显著差异(HR=1.251,95%CI:0.151~10.387,P=0.430;HR=0.836,95%CI:0.177~3.935,P=0.820)。结论基于临床变量的ACEF评分对于在这一特定人群中缺乏进一步危险分层和评价预后的能力。
Objective To study the role of ACEF score in assessment of primary PCI for≥75 years old STEMI patients.Methods One hundred and four STEMI patients who underwent primary PCI in our hospital from November 2011 to January 2014 were divided into low-moderate risk group（n=18）with an ACEF score of 1.18±0.09 and high risk group（n=86）with an ACEF score of 1.63±0.05.Their primary endpoints were 30-day and 1-year all-cause mortality after primary PCI.Relationship between ACEF score and ontcome in two groups was analyzed by univariate Cox regression analysis.The 30-day and 1-year all-cause mortalities were predicted according to their ROC.Results The incidence of ischemic stroke and the LVEF were significantly higher while the age was significantly younger,the body height and the ratio of male patients were significantly lower in low-moderate risk group than in high risk group.The area under the AUC for 30-day and 1-year mortality was 0.669 and 0.680 respectively.Univariate Cox regression analysis showed no significant difference in 30-day and 1-year mortality between the two groups（HR=1.251,95%CI：0.151-10.387,P=0.430;HR=0.836,95%CI：0.177-3.935,P=0.820）.Conclusion ACEF score does not play an effective role in risk stratification and outcome assessment in elderly STEMI patients.
出处
《中华老年心脑血管病杂志》
CAS
2017年第12期1260-1263,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
