目的评价Logistic Euro SCORE与Euro SCOREⅡ风险预测模型对本中心成人单纯二尖瓣置换术后在院死亡率预测的准确性。方法回顾性收集2009年1月至2013年12月497例患者在院接受单纯二尖瓣置换术的临床资料,包括同期行三尖瓣成形、左房减容...目的评价Logistic Euro SCORE与Euro SCOREⅡ风险预测模型对本中心成人单纯二尖瓣置换术后在院死亡率预测的准确性。方法回顾性收集2009年1月至2013年12月497例患者在院接受单纯二尖瓣置换术的临床资料,包括同期行三尖瓣成形、左房减容、左心耳闭合术患者。其中男性186例,女性311例,平均(53.19±11.11)岁。按照第一版的Logistic Euro SCORE模型与新版的Euro SCOREⅡ模型给予评分获得患者的预测死亡率,与患者的实际在院死亡率比较。模型预测的符合程度应用Hosmer-Lemeshow拟和优度检验,而预测的鉴别效度则通过受试者工作特征曲线(ROC)下面积反映。结果497例患者在院死亡6例,全组实际在院死亡率为1.21%,logistic Euro SCORE及Euro SCOREⅡ预测的在院死亡率分别为2.99%和1.53%。其中Euro SCOREⅡ对全组患者在院死亡率预测符合程度较高,而logistic Euro SCORE明显高估了在院死亡率。logistic Euro SCORE的区分度及校准度差(P=0.673,AUC=0.621),Euro SCOREⅡ区分度及校准度均较好(P=0.894,AUC=0.793)。结论 Euro SCOREⅡ对本中心单纯二尖瓣置换手术患者在院死亡风险预测的准确性较高。展开更多
Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI...Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.展开更多
文摘目的评价Logistic Euro SCORE与Euro SCOREⅡ风险预测模型对本中心成人单纯二尖瓣置换术后在院死亡率预测的准确性。方法回顾性收集2009年1月至2013年12月497例患者在院接受单纯二尖瓣置换术的临床资料,包括同期行三尖瓣成形、左房减容、左心耳闭合术患者。其中男性186例,女性311例,平均(53.19±11.11)岁。按照第一版的Logistic Euro SCORE模型与新版的Euro SCOREⅡ模型给予评分获得患者的预测死亡率,与患者的实际在院死亡率比较。模型预测的符合程度应用Hosmer-Lemeshow拟和优度检验,而预测的鉴别效度则通过受试者工作特征曲线(ROC)下面积反映。结果497例患者在院死亡6例,全组实际在院死亡率为1.21%,logistic Euro SCORE及Euro SCOREⅡ预测的在院死亡率分别为2.99%和1.53%。其中Euro SCOREⅡ对全组患者在院死亡率预测符合程度较高,而logistic Euro SCORE明显高估了在院死亡率。logistic Euro SCORE的区分度及校准度差(P=0.673,AUC=0.621),Euro SCOREⅡ区分度及校准度均较好(P=0.894,AUC=0.793)。结论 Euro SCOREⅡ对本中心单纯二尖瓣置换手术患者在院死亡风险预测的准确性较高。
文摘Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.
