Predictors of hospital mortality in the global registry of acute coronary events
Predictors of hospital mortality in the global registry of acute coronary events
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DOI：
10.1001/archinte.163.19.2345
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发表时间：
2003-10-27
影响因子：
--
通讯作者：
Fox, KAA
中科院分区：
文献类型：
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作者：
Granger, CB;Goldberg, RJ;Fox, KAA
背景：急性冠脉综合征的管理应该以对患者风险的估计为指导。目的：建立一个简单的模型来评估在一般临床实践中接受治疗的所有急性冠脉综合征患者的住院死亡率风险。方法：对1999年4月1日至2001年3月31日全球急性冠脉事件登记系统(GRACE)登记的11389例有或无ST段抬高的急性冠脉综合征患者(包括509例住院死亡)，建立了多变量Logistic回归模型。结果：以下8个独立危险因素占预后信息的89.9%：年龄(优势比[OR]，每10年1.7)，Killip分级(OR，每类2.0)，收缩压(OR，每20 mm Hg下降1.4)，ST段偏离(OR，2.4)，临床期心脏骤停(OR，4.3)，血清肌酐水平(OR，1.2.每1 mg/dL[88.4Mumol/L]增加)、初始心肌酶检查阳性(OR1.6)和心率(OR1.3)。简化模型的判别能力很好，在派生数据库中的c统计量为0.83，在确认GRACE数据集中为0.84，在GUSTO-IIb数据库中为0.79。结论：在整个急性冠脉综合征谱和一般临床实践中，该模型提供了良好的死亡风险评估能力，可作为估计单个患者风险的简单诺模图。
Background: Management of acute coronary syndromes (ACS) should be guided by an estimate of patient risk.Objective: To develop a simple model to assess the risk for in-hospital mortality for the entire spectrum of ACS treated in general clinical practice.Methods: A multivariable logistic regression model was developed using 11389 patients (including 509 in-hospital deaths) with ACS with and without ST-segment elevation enrolled in the Global Registry of Acute Coronary Events (GRACE) from April 1, 1999, through March 31, 2001. Validation data sets included a subsequent cohort of 3972 patients enrolled in GRACE and 12142 in the Global Use of Strategies to Open Occluded Coronary Arteries IIb (GUSTO-IIb) trial.Results: The following 8 independent risk factors accounted for 89.9% of the prognostic information: age (odds ratio [OR], 1.7 per 10 years), Killip class (OR, 2.0 per class), systolic blood pressure (OR, 1.4 per 20-mm Hg decrease), ST-segment deviation (OR, 2.4), cardiac arrest during presentation (OR, 4.3), serum creatinine level (OR, 1.2 per 1-mg/dL [88.4-mumol/L] increase), positive initial cardiac enzyme findings (OR, 1.6), and heart rate (OR, 1.3 per 30-beat/min increase). The discrimination ability of the simplified model was excellent with c statistics of 0.83 in the derived database, 0.84 in the confirmation GRACE data set, and 0.79 in the GUSTO-IIb database.Conclusions: Across the entire spectrum of ACS and in general clinical practice, this model provides excellent ability to assess the risk for death and can be used as a simple nomogram to estimate risk in individual patients.