主动脉内球囊反搏-休克Ⅱ风险评分对国人急性心肌梗死合并心原性休克患者30天死亡率的预测价值

Predictive Value of IABP-SHOCK Ⅱ Risk Score for 30-day Mortality in Chinese Patients With Cardiogenic Shock After Acute Myocardial Infarction

目的:探讨主动脉内球囊反搏-休克(IABP-SHOCK)Ⅱ风险评分对国人急性心肌梗死合并心原性休克患者30天死亡率的预测价值。方法:收集2014-06至2017-07在我院因急性心肌梗死合并心原性休克置入主动脉内球囊反搏(IABP)且行急诊冠状动脉造影的患者212例,根据IABP-SHOCKⅡ风险评分分为0~2分组(n=106)、3~4分组(n=56)及5~9分组(n=50)。收集患者临床资料,记录住院期间及诊断后30天内死亡率。结果:与0~2分组比,3~4分组和5~9分组的年龄大,合并脑卒中患者比例高,心肌梗死溶栓治疗临床试验(TIMI)血流恢复3级患者比例低,乳酸、就诊血糖及血肌酐水平升高,差异均有统计学意义(P均<0.05)。与0~2分组比,5~9分组的男性患者比例低,差异有统计学意义(P<0.05)。与3~4分组比,5~9分组合并脑卒中患者比例高,TIMI血流恢复3级患者比例低,乳酸及血肌酐水平升高,差异均有统计学意义(P均<0.05)。三组患者30天内共累计死亡68例,其中0~2分组7例(6.6%),3~4分组21例(37.5%),5~9分组40例(80.0%),三组间死亡率差异有统计学意义(P<0.05)。IABP-SHOCKⅡ风险评分的受试者工作特征曲线显示:曲线下面积=0.853,95%CI:0.796~0.911。结论:IABP-SHOCKⅡ风险评分简单易操作,可适用于中国人群,有助于实现急性心肌梗死合并心原性休克患者IABP置入术后的分层治疗。

Objectives： To investigate the predictive value of IABP-SHOCK Ⅱ risk score for 30-day mortality in Chinese patients with cardiogenic shock after acute myocardial infarction.Methods： A total of 212 hospitalized Chinese patients with cardiogenic shock after acute myocardial infarction were enrolled from June 2014 to July 2017. The IABP-SHOCKⅡrisk score was calculated at admission. The endpoint of this study was all-cause 30-day death. The predictive value of IABP-SHOCK Ⅱ risk score for these patients was assessed by calculating the area under receiver operating characteristic（ROC） curve. Results： According to the IABP-SHOCKⅡrisk score at admission, the patients were divided into 3 groups：score 0-2 group, n =106; score 3-4 group, n =56 and score 5-9 group, n =50. Patients were older, incidence of cerebral stroke, lacticacid, glucose at admission and creatinine levels were higher. while incidence of TIMI grade 3 was lower in score 3-4 group and score 5-9 group than in score 0-2 group（all P〈0.05）. Percent of male patients was lower in score 5-9 group than in score 0-2 group（P〈0.05）. Incidence of cerebral stroke, lactic acid, and creatinine levels were higher. while incidence of TIMI grade 3 was lower in score 5-9 group than in score 3-4 group（all P〈0.05）. Sixty-eight patients died during the 30 days follow-up, mortality was 6.6%, 37.5% and 80% in the score 0-2 group, score 3-4 group, and score 5-9 group, respectively（P〈0.05）. The ROC curve analysis showed that AUC was 0.853, and 95%CI was 0.796-0.911. Conclusions： IABP-SHOCK Ⅱ risk score is suitable for risk stratification and assessment of 30-day mortality in Chinese patients with cardiogenic shock after acute myocardial infarction and may facilitate the clinical decision making to improve the outcome of these patients.