China PEACE risk estimation tool for in-hospital death from acute myocardial infarction: an early risk classification tree for decisions about fibrinolytic therapy.
China PEACE risk estimation tool for in-hospital death from acute myocardial infarction: an early risk classification tree for decisions about fibrinolytic therapy.
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DOI：
10.1136/bmjopen-2016-013355
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发表时间：
2016-10-24
期刊：
影响因子：
2.9
通讯作者：
China PEACE Collaborative Group
中科院分区：
文献类型：
--
作者：
Li X;Li J;Masoudi FA;Spertus JA;Lin Z;Krumholz HM;Jiang L;China PEACE Collaborative Group
在许多国家，作为ST段抬高型心肌梗死（STEMI）的主要急性再灌注治疗方法，纤溶治疗在基线风险范围内可使死亡相对风险降低约16%。对于基线死亡风险较低的患者，纤溶治疗因此可能提供很少的益处，这可能被大出血的风险所抵消。我们的目的是建立一个工具来确定是否有可能在符合纤溶治疗条件的患者中识别低风险组。横断面研究。中国以患者为中心的心脏事件评价评估（PEACE）研究包括162家医院急性心肌梗死（AMI）住院患者的全国代表性回顾性样本。3741例符合纤溶条件但未接受再灌注治疗的STEMI患者。住院死亡率，定义为住院期间发生的死亡或因出院时终末期状态而退出治疗的死亡总和。在研究队列中，住院死亡率为14.7%。在衍生队列和验证队列中，收缩压（≥100 mm Hg）、年龄（<60岁）和性别（男性）的组合确定了五分之一的队列，平均死亡率<3.0%。在这个低风险组中，一半的非前侧ami患者的平均住院死亡风险为1.5%。近五分之一符合纤溶治疗条件的STEMI患者院内死亡风险较低。有三个简单的因素可以识别这些个体，并支持使用纤溶治疗的决策。NCT01624883。
As the predominant approach to acute reperfusion for ST segment elevation myocardial infarction (STEMI) in many countries, fibrinolytic therapy provides a relative risk reduction for death of ∼16% across the range of baseline risk. For patients with low baseline mortality risk, fibrinolytic therapy may therefore provide little benefit, which may be offset by the risk of major bleeding. We aimed to construct a tool to determine if it is possible to identify a low-risk group among fibrinolytic therapy-eligible patients. Cross-sectional study. The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) study includes a nationally representative retrospective sample of patients admitted with acute myocardial infarction (AMI) in 162 hospitals. 3741 patients with STEMI who were fibrinolytic-eligible but did not receive reperfusion therapy. In-hospital mortality, which was defined as a composite of death occurring within hospitalisation or withdrawal from treatment due to a terminal status at discharge. In the study cohort, the in-hospital mortality was 14.7%. In the derivation cohort and the validation cohort, the combination of systolic blood pressure (≥100 mm Hg), age (<60 years old) and gender (male) identified one-fifth of the cohort with an average mortality rate of <3.0%. Half of this low risk group—those with non-anterior AMI—had an average in-hospital death risk of 1.5%. Nearly, one in five patients with STEMI who are eligible for fibrinolytic therapy are at a low risk for in-hospital death. Three simple factors available at the time of presentation can identify these individuals and support decision-making about the use of fibrinolytic therapy. NCT01624883.
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影响因子：
37.8
作者：
Adams, RJ;Antman, EM;Kavey, REW
通讯作者：
Kavey, REW
DOI：
10.1161/circoutcomes.113.000441
发表时间：
2013-11
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Dharmarajan K;Li J;Li X;Lin Z;Krumholz HM;Jiang L;China PEACE Collaborative Group
通讯作者：
China PEACE Collaborative Group
影响因子：
168.9
作者：
Morrow, DA;Antman, EM;Braunwald, E
通讯作者：
Braunwald, E
影响因子：
37.8
作者：
Krumholz, HM;Chen, J;Marciniak, TA
通讯作者：
Marciniak, TA
影响因子：
105.7
作者：
Baigent, C;Collins, R;Peto, R
通讯作者：
Peto, R