Validity of Charlson Comorbidity Index in patients hospitalised with acute coronary syndrome. Insights from the nationwide AMIS Plus registry 2002-2012
Validity of Charlson Comorbidity Index in patients hospitalised with acute coronary syndrome. Insights from the nationwide AMIS Plus registry 2002-2012
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DOI：
10.1136/heartjnl-2013-304588
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发表时间：
2014-02-15
期刊：
影响因子：
5.7
通讯作者：
Erne, Paul
中科院分区：
文献类型：
--
作者：
Radovanovic, Dragana;Seifert, Burkhardt;Erne, Paul
目的探讨Charlson合并症指数（CCI）对急性冠脉综合征（ACS）患者预后的权重分配、预测特性和判别能力。方法一项前瞻性多中心观察性研究（AMIS Plus Registry），来自69家瑞士医院的29620名ACS患者于2002年至2012年入组。主要结局指标为住院死亡率和1年随访死亡率。结果女性占27%，年龄72.1 +/- 12.6岁，男性占73%，年龄64.2 +/- 12.9岁。46.8%的患者有合并症，他们接受指南推荐的药物治疗和再灌注的可能性较小。心力衰竭（校正OR 1.88; 95% CI 1.57 ~ 2.25）、转移性肿瘤（OR 2.25; 95% CI 1.60 ~ 3.19）、肾脏疾病（OR 1.84; 95% CI 1.60 ~ 2.11）和糖尿病（OR 1.35; 95% CI 1.19 ~ 1.54）是院内死亡率的强预测因子。在该人群中，CCI对既往心肌梗死史的权重高于基准（1而不是-0.4,95% CI为-1.2至0.3），但对心力衰竭（1而不是3.7,95% CI为2.6至4.7）和肾脏疾病（2而不是3.5,95% CI为2.7至4.4）的权重低于基准，其中所有合并症、年龄和性别都被用作预测因素。然而，具有CCI和年龄的模型与该基准具有相同的判别性（受试者工作特征曲线下面积均为0.76）。结论合并症对ACS患者的临床表现、所接受的治疗及转归有很大影响。心力衰竭、糖尿病、肾脏疾病或转移性肿瘤对死亡率有重大影响。CCI似乎是ACS患者住院和1年预后的适当预后指标。
Objective This study aimed to assess the impact of individual comorbid conditions as well as the weight assignment, predictive properties and discriminating power of the Charlson Comorbidity Index (CCI) on outcome in patients with acute coronary syndrome (ACS).Methods A prospective multicentre observational study (AMIS Plus Registry) from 69 Swiss hospitals with 29 620 ACS patients enrolled from 2002 to 2012. The main outcome measures were in-hospital and 1-year follow-up mortality.Results Of the patients, 27% were female (age 72.1 +/- 12.6 years) and 73% were male (64.2 +/- 12.9 years). 46.8% had comorbidities and they were less likely to receive guideline-recommended drug therapy and reperfusion. Heart failure (adjusted OR 1.88; 95% CI 1.57 to 2.25), metastatic tumours (OR 2.25; 95% CI 1.60 to 3.19), renal diseases (OR 1.84; 95% CI 1.60 to 2.11) and diabetes (OR 1.35; 95% CI 1.19 to 1.54) were strong predictors of in-hospital mortality. In this population, CCI weighted the history of prior myocardial infarction higher (1 instead of -0.4, 95% CI -1.2 to 0.3 points) but heart failure (1 instead of 3.7, 95% CI 2.6 to 4.7) and renal disease (2 instead of 3.5, 95% CI 2.7 to 4.4) lower than the benchmark, where all comorbidities, age and gender were used as predictors. However, the model with CCI and age has an identical discrimination to this benchmark (areas under the receiver operating characteristic curves were both 0.76).Conclusions Comorbidities greatly influenced clinical presentation, therapies received and the outcome of patients admitted with ACS. Heart failure, diabetes, renal disease or metastatic tumours had a major impact on mortality. CCI seems to be an appropriate prognostic indicator for in-hospital and 1-year outcomes in ACS patients.