衰弱评估在预测老年急性心肌梗死患者冠状动脉介入术后再发心肌梗死中的作用

Study on frailty assessment predicting the PCI post-operative recurrence of myocardial infarction in elderly patients with acute myocardial infarction

目的探讨衰弱评估在预测老年急性心肌梗死(AMI)患者冠状动脉介入术(PCI)后再发心肌梗死中的作用。方法选取2019年7月-2020年1月及2020年5-8月滨州医学附属医院心血管内科择期行PCI的老年AMI患者416例,术前应用Fried衰弱表型量表对患者进行衰弱评估,并随访记录患者出院后3个月内心肌再梗入院的发生情况。运用受试者工作特性曲线(ROC)评价衰弱评估在预测患者术后发生心肌再梗的准确度及最佳临界值。结果衰弱的老年AMI患者行择期PCI术后心肌再梗的发生率高于非衰弱患者(P<0.05);衰弱评估对患者出院后3个月内发生心肌再梗入院的预测ROC曲线下面积为0.715,最佳临界值为3分,对应的约登指数最大为0.414,灵敏度为67.5%,特异度为73.9%。结论对择期行PCI的老年AMI患者术前进行衰弱评估,可较准确预测患者术后心肌再梗的发生风险,提示术前评估为衰弱的患者在PCI术后应警惕心肌再梗的发生。

Objective To explore frailty assessment predicting the risk of postoperative recurrence of myocardial infarction in elderly acute myocardial infarction patients with PCI.Methods We selected 416 elderly AMI patients with PCI in the cardiology department of the province grade 3A hospital from July 2019 to January 2020 and May 2020 to August 2020,evaluated all patients with the fried frailty phenotype scale before operation,observed and record the recurrence of myocardial infarction within 3 months after discharge.The receiver operating characteristic curve(ROC)was run to identify the accuracy and optimal high risk cut-off point off railty assessment predicting postoperative myocardial re-infarction.Results The incidence of recurrent myocardial infarction in patients with frailty after PCI was higher than non-frailty patients(P<0.05).The area under curve(AUC)off railty assessment predicting postoperative myocardial re-infarction was 0.715,the cut-off point was 3,the largest Youden's index was 0.414,the sensitivity was 67.5%,the specificity was 73.9%.Conclusions Frailty assessment by using the fried frailty phenotype scale in the elderly acute myocardial infarction patients before the PCI,can accurately predict the risk of postoperative recurrence of myocardial infarction,the patients who were frailty by preoperative frailty assessment should be vigilant to prevent postoperative myocardial re-infarction.