Comparison of Prognostic Value of Echocardiacgraphic Risk Score With the Thrombolysis In Myocardial Infarction (TIMI) and Global Registry In Acute Coronary Events (GRACE) Risk Scores in Acute Coronary Syndrome
Comparison of Prognostic Value of Echocardiacgraphic Risk Score With the Thrombolysis In Myocardial Infarction (TIMI) and Global Registry In Acute Coronary Events (GRACE) Risk Scores in Acute Coronary Syndrome
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DOI：
10.1016/j.amjcard.2010.08.024
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发表时间：
2010-12-15
影响因子：
2.8
通讯作者：
Picano, Eugenio
中科院分区：
文献类型：
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作者：
Bedetti, Gigliola;Gargani, Luna;Picano, Eugenio
如今，急性冠脉综合征 (ACS) 患者的风险分层是通过临床模型实现的，对影像学方法的预后支持“视而不见”。为了评估简单静息胸部超声检查在预测院内和院外死亡或心肌梗死风险方面的价值，我们连续招募了 470 名因 ACS 入院的住院患者（312 名男性，年龄 71 +/- 12 岁）。入院时，所有患者均通过急性冠脉事件和心肌梗死系统溶栓全球登记系统获得临床评分，并在 1 至 12 小时内接受全面的心胸超声扫描。评估左、右、收缩和舒张、心室功能和结构的 16 个超声心动图参数中的每一个都从 0（正常）到 3（严重异常）进行评分。中位随访时间为 5 个月（四分位数范围 1 至 10）。使用急性冠脉事件全球登记评分、心肌梗死溶栓评分和一些超声心动图参数，可以将患有严重事件的患者 (n = 102) 与没有事件的患者 (n = 368) 分开。多变量 Cox 分析、射血分数（风险比 1.45，95% 置信区间 1.02 至 2.08，p = 0.040）、三尖瓣环平面收缩期偏移（风险比 1.66，95% 置信区间 1.13 至 2.45，p = 0.010）和超声肺彗星（风险比 1.69， 95% 置信区间（1.25 至 2.27，p = 0.001）是心脏事件的独立预测因子。 3 变量超声心动图评分（从 0、正常到 9、射血分数严重异常、超声肺彗星和三尖瓣环平面收缩期偏移）有效地对患者进行了分层并增加了价值（风险比 2.52，95% 置信区间 1.89 至 3.37，p
Risk stratification in patients with acute coronary syndromes (ACS) is achieved today by clinical models, "blind" to the prognostic support of imaging methods. To assess the value of simple at rest cardiac chest sonography in predicting the intra- and extrahospital risk of death or myocardial infarction, we enrolled 470 consecutive in-patients (312 men, age 71 +/- 12 years) who had been admitted for ACS. On admission, all had received a clinical score using the Global Registry in Acute Coronary Events and Thrombolysis in Myocardial Infarction systems and, within 1 to 12 hours, a comprehensive cardiac-chest ultrasound scan. Each of the 16 echocardiographic parameters evaluating left and right, systolic and diastolic, ventricular function and structure, was scored from 0 (normal) to 3 (severely abnormal). The median follow-up was 5 months (interquartile range 1 to 10). Patients with hard events (n = 102) could be separated from patients without events (n = 368) using the Global Registry in Acute Coronary Events score, Thrombolysis in Myocardial Infarction score, and several echocardiographic parameters. On multivariate Cox analysis, ejection fraction (hazard ratio 1.45, 95% confidence interval 1.02 to 2.08, p = 0.040), tricuspid annular plane systolic excursion (hazard ratio 1.66, 95% confidence interval 1.13 to 2.45, p = 0.010) and ultrasound lung comets (hazard ratio 1.69, 95% confidence interval 1.25 to 2.27, p = 0.001) were independent predictors of cardiac events. The 3-variable echocardiographic score (from 0, normal to 9, severe abnormalities in ejection fraction, ultrasound lung comets, and tricuspid annular plane systolic excursion) effectively stratified patients and added value (hazard ratio 2.52, 95% confidence interval 1.89 to 3.37, p