休克指数对急性ST段抬高型心肌梗死患者院内死亡的预测价值

Value of shock index to predicting in-hospital death in patients with acute ST-segment elevation myocardial infarction

目的探讨休克指数(shock index,SI)在急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者院内死亡预测中的价值。方法STEMI患者1 686例,均测量入院时收缩压、心率,计算SI,绘制ROC曲线评估SI预测STEMI院内死亡的效能;将1 686例患者根据SI最佳截断值分为低SI组(SI<0.682)1218例和高SI组(SI≥0.682)468例,比较2组一般资料、临床特征、治疗及预后情况,广义混合效应模型回归分析SI与STEMI患者院内死亡的关系。结果ROC曲线分析显示,SI以0.682为最佳截断值,预测STEMI患者院内死亡的AUC为0.729(95%CI:0.671~0.788,P<0.001),灵敏度为67.7%,特异度为74.2%;高SI组中位年龄(66.43岁)较低SI组(63.30岁)大,女性(31.41%)及入院时前壁心肌梗死(65.17%)、合并心律失常(28.21%)、心功能Killip分级2~4级(49.57%)、心率>100次/min(30.13%)、收缩压<90mm Hg(8.33%)、使用β受体阻滞剂治疗比率(63.68%)及院内病死率(13.25%)均高于低SI组(25.86%、53.12%、15.11%、31.69%、2.30%、0.99%、57.55%、2.71%),有高血压史(38.68%)、发病12h内接受再灌注治疗(33.55%)及使用阿司匹林(95.51%)、氯吡格雷(89.10%)、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂(43.59%)、替罗非班治疗比率(5.98%)低于低SI组(49.92%、40.80%、97.37%、92.36%、51.89%、9.20%)(P<0.05);多因素广义混合效应模型回归分析结果显示,SI≥0.682(OR=4.02,95%CI:2.33~6.94,P<0.001)是STEMI患者院内死亡的危险因素。结论SI在预测STEMI患者院内死亡中具有较高的价值,SI≥0.682者院内死亡风险明显增高。

Objective To investigate the value of shock index(SI)to predicting in-hospital death in patients with acute ST-elevation myocardial infarction(STEMI).Methods Totally 1 688STEMI patients were measured systolic blood pressure and heart rate at admission to calculate the SI.ROC was drawn to assess the efficiency of SI on predicting in-hospital death in STEMI patients.According to the optimal cut-off value,1 688patients were divided into 1 218 patients with SI<0.682(low-SI group)and 468patients with SI≥0.682(high-SI group).The general data,clinical features,treatment and prognosis were compared between two groups.Generalized linear mixed model was adopted to analyze the relationship between SI and in-hospital death.Results When the optimal cut-offof SI was 0.682,the AUC for in-hospital death was 0.729(95%CI:0.671-0.788,P<0.001),the sensitivity was 67.7%and the specificity was 74.2%.High-SI group had older median age(66.43years),higher percentages of females,anterior myocardial infarction,arrhythmia,Killip class 2-4,heart rate>100beat/min,systolic blood pressure<90mm Hg andβ-blocker application at admission(31.41%,65.17%,28.21%,49.57%,30.13%,8.33%,63.65%),higher in-hospital fatality(13.25%),and lower percentages of hypertension,early reperfusion in 12has well as applications of aspirin,clopidogrel,angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and tirofiban(38.68%,33.55%,95.51%,89.10%,43.59%,5.98%)significantly than those in low-SI group(63.30years,25.86%,53.12%,15.11%,31.69%,2.30%,0.99%,57.55%,2.71%,49.92%,40.80%,97.37%,92.36%,51.89%,9.20%)(P<0.05).Generalized linear mixed analysis indicated that SI≥0.682(OR=4.02,95%CI:2.33-6.94,P<0.001)was a risk factor for in-hospital death of STEMI patients.Conclusion SI has a high value to predicting the risk factors for in-hospital death of STEMI patients,and those with SI≥0.682have a higher risk for in-hospital death.