Application of the thrombolysis in myocardial infarction risk index in non-ST-segment elevation myocardial infarction - Evaluation of patients in the National Registry of Myocardial Infarction
Application of the thrombolysis in myocardial infarction risk index in non-ST-segment elevation myocardial infarction - Evaluation of patients in the National Registry of Myocardial Infarction
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DOI：
10.1016/j.jacc.2005.11.075
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发表时间：
2006-04-18
影响因子：
24
通讯作者：
Braunwald, E
中科院分区：
文献类型：
--
作者：
Wiviott, SD;Morrow, DA;Braunwald, E
本研究的目的是评估心肌梗死溶栓风险指数（TRI），以描述非ST段抬高型心肌梗死（NSTEMI）患者的死亡风险。背景TRI，根据基线年龄，收缩压和心率计算，在ST段抬高型心肌梗死（STEMI）患者中建立，并预测死亡率。与STEMI相比，出现NSTEMI的患者增加，构成了一组具有不同风险的患者。方法：在337，192例来自国家心肌梗死登记处的患者中计算TRI，并将NSTEML值和结果与153，486例按再灌注状态分类的STEMI患者进行比较。比较基线特征和按TRI分层的临床结局。结果TRI与NSTEMI患者的死亡率之间存在分级关系，最低和最高十分位数之间的死亡率差异> 30倍（p < 0.0001）。该指数显示出良好的区分度（c = 0.73）。NSTEMI组的总体死亡率（10.9%）高于接受再灌注治疗的STEMI患者（6.6%），但低于未接受再灌注治疗的STEMI患者（18.7%）。与STEMI患者再灌注治疗相比，较高的风险很大程度上是由NSTEMI人群的高风险特征解释的。这个简单的风险指数提供了关于心肌梗死、STEMI和NSTEMI患者死亡率的重要信息。早期识别具有院内死亡高风险的NSTEMI患者可为临床医生提供重要信息，用于初始分诊和治疗。
OBJECTIVES The purpose of this research was to evaluate the Thrombolysis In Myocardial Infarction risk index (TRI) to characterize the risk of death among patients with non-ST-segment elevation myocardial infarction (NSTEMI).BACKGROUND The TRI, calculated from baseline age, systolic pressure, and heart rate, was established in patients with ST-segment elevation myocardial infarction (STEMI) and is predictive of mortality. Patients presenting with NSTEMI are increasing compared to STEMI and constitute a group with varied risk.METHODS The TRI was calculated in 337,192 patients from the National Registry of Myocardial Infarction with NSTEML Values and outcomes were compared with 153,486 patients with STEMI classified by reperfusion status. Comparisons of baseline characteristics and clinical outcomes stratified by TRI were made.RESULTS There was a graded relationship between the TRI and mortality in patients with NSTEMI with a > 30-fold difference in mortality rates between lowest and highest deciles (p < 0.0001). The index showed good discrimination (c = 0.73). Overall mortality in the group with NSTEMI was higher (10.9%) than patients with STEMI treated with (6.6%) but lower than for STEMI patients not receiving reperfusion therapy (18.7%). The higher risk in comparison to patients with STEMI treated with reperfusion therapy was explained largely by the higher-risk profile of the population with NSTEMI.CONCLUSIONS There is a graded relationship between TRI and mortality in patients with NSTEMI. This simple risk index provides important information about mortality in patients across the spectrum of myocardial infarction, STEMI and NSTEMI. Early identification of NSTEMI patients who are at high risk of in-hospital mortality may provide clinicians with important information for initial triage and treatment.