Prediction of outcome after percutaneous coronary intervention for the acute coronary syndrome
Prediction of outcome after percutaneous coronary intervention for the acute coronary syndrome
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DOI：
10.1016/j.amjmed.2003.09.021
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发表时间：
2003-12-15
影响因子：
5.9
通讯作者：
Sharma, SK
中科院分区：
文献类型：
--
作者：
Kini, AS;Lee, PC;Sharma, SK
背景技术背景：七组分心肌梗死溶栓（TIMI）评分已用于风险分层，并指导不稳定型心绞痛或非ST段抬高型心肌梗死患者的医疗管理。我们评估了风险评分在预测接受经皮冠状动脉介入治疗的患者的住院和30天预后中的有用性。方法：使用TIMI评分，2501例不稳定型心绞痛或非ST段抬高型心肌梗死患者被分为低风险组和低风险组。（0至2个风险因素; n = 974），中等风险（3至4个风险因素; n = 1339），和高风险结果：三组之间的血管造影/临床成功率和轻微手术事件发生率相似。TIMI风险评分越高，心脏合并症越多，血管造影病变越复杂：病变越长（P = 0.0009），血栓性病变越多（P = 0.03），多支血管病变越多（P < 0.0001），美国心脏病学会/美国心脏协会B2/C型病变越多（P = 0.05）。尽管风险评分不能预测介入技术成功或术中并发症，但高评分与住院时间延长、术后肌钙蛋白峰值水平升高和30天主要不良心脏事件相关。逐步logistic回归显示，与病变长度和患者性别相结合，高分是30天主要不良心脏事件的独立预测因子（比值比= 2.3; 95%置信区间：1.1至4.1; C统计量= 0.62）。尽管不稳定型心绞痛或非ST段抬高型心绞痛患者TIMI风险评分较高，对于正在接受经皮冠状动脉介入治疗的急性心肌梗死患者，与不良临床结局相关，单独的评分不能用于指导诊断或治疗策略。(C)2003年，Excerpta Medica Inc.
BACKGROUND: The seven-component Thrombolysis In Myocardial Infarction (TIMI) score has been used to risk stratify, and to guide the medical management of, patients with unstable angina or non-ST-elevation myocardial infarction. We assessed the usefulness of the risk score in predicting in-hospital and 30-day outcomes in such patients who were undergoing percutaneous coronary intervention.METHODS: Using the TIMI score, 2501 patients with unstable angina or non-ST-elevation myocardial infarction were divided into low-risk (zero to two risk factors; n = 974), intermediate-risk (three to four risk factors; n = 1339), and high-risk (five to seven risk factors; n = 188) groups, and outcomes were compared.RESULTS: Angiographic/clinical success and the rate of minor procedural events were similar among the three groups. A higher TIMI risk score was associated with more cardiac comorbid conditions and more complicated angiographic lesions: longer lesions (P = 0.0009), more thrombotic lesions (P = 0.03), more multivessel disease (P < 0.0001), and more American College of Cardiology/American Heart Association type B2/C lesions (P = 0.05). Although the risk score did not predict interventional technical success or intraprocedural complications, a high score was associated with prolonged hospital stay, higher postprocedural peak troponin levels, and 30-day major adverse cardiac events. Stepwise logistic regression showed that in conjunction with lesion length and patient sex, a high score was an independent predictor of 30-day major adverse cardiac events (odds ratio = 2.3; 95% confidence interval: 1.1 to 4.1; C statistic = 0.62).CONCLUSION: Although a higher TIMI risk score in patients with unstable angina or non-ST-elevation myocardial infarction who were undergoing percutaneous coronary intervention correlated with adverse clinical outcome, the score alone cannot be used to guide diagnostic or therapeutic strategies. (C) 2003 by Excerpta Medica Inc.