急性ST段抬高型心肌梗死患者预后急诊简易预测模型的构建

Predictive value of simple predictive model for prognosis of patients with acute ST-segment elevation myocardial infarction

目的探究简易预测模型对急性心肌梗死患者预后的预测价值。方法回顾性分析2019年1月至2020年1月在四川大学华西医院急诊科明确诊断为急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)280例患者的临床资料。将其分为死亡组(n=34)和生存组(n=246)。结果生存组年龄、心率、体重指数(body mass index,BMI)、全球急性冠状动脉事件注册(GRACE)评分、心肌梗死溶栓治疗临床试验(TIMI)评分、尿素氮、血清胱抑素C、D-二聚体均低于死亡组(P<0.05);生存组左室射血分数,白蛋白、甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平大于或高于死亡组(P<0.05);死亡组总Killip分级>Ⅲ级比例高于生存组(P<0.05)。采用多因素logistic回归分析显示年龄、BMI、心率、舒张压、收缩压为STEMI患者全因死亡独立危险因素。受试者工作特征曲线分析显示预测模型判断死亡的曲线下面积是0.802,GRACE判断死亡的曲线下面积是0.816,二者差异无统计学意义。H-L检验显示预测模型判断死亡具有较高的准确性(χ^(2)=3.77,P=0.877)。Pearson相关性分析显示预测模型与GRACE(r=0.651,P<0.001)及冠状动脉狭窄程度评分(r=0.210,P=0.001)呈正相关。结论简易预测模型可用于预测STEMI患者住院及远期预后,有利于对疾病早期进行风险分层并指导治疗。

Objective To explore the predictive value of a simple prediction model for patients with acute myocardial infarction. Methods Clinical data of 280 patients with acute ST-segment elevation myocardial infarction(STEMI) in the Department of Emergence Medicine, West China Hospital of Sichuan University from January 2019 to January 2020 were retrospectively analyzed. The patients were divided into a death group(n=34) and a survival group(n=246). Results Age, heart rate, body mass index(BMI), global registry of acute coronary events(GRACE),thrombolysis in myocardial infarction trial(TIMI) score, blood urea nitrogen, serum cystatin C and D-dimer in the survival group were less or lower than those in the death group(P<0.05). Left ventricle ejection fraction and the level of albumin, triglyceride, total cholesterol and low density lipoprotein cholesterol were higher and the incidence of Killip class≥Ⅲ was lower in the survival group compared to the death group(P<0.05). Multivariate logistic regression analysis showed that age, BMI, heart rate, diastolic blood pressure, and systolic blood pressure were independent risk factors for all-cause death in STEMI patients. Receiver operating characteristic(ROC) curve analysis showed that the area under the curve of simple prediction model for predicting death was 0.802, and similar to that of GRACE(0.816). The H-L test showed that the simple model had high accuracy in predicting death(χ^(2)=3.77, P=0.877). Pearson correlation analysis showed that the simple prediction model was significantly correlated with the GRACE(r=0.651, P<0.001) and coronary artery stenosis score(r=0.210, P=0.001). Conclusion The simple prediction model may be used to predict the hospitalization and long-term outcomes of STEMI patients, which is helpful to stratify high risk patients and to guide treatment.