Use of a simple clinical score to predict prognosis of patients with normal or mildly abnormal resting electrocardiographic findings undergoing evaluation for coronary artery disease
Use of a simple clinical score to predict prognosis of patients with normal or mildly abnormal resting electrocardiographic findings undergoing evaluation for coronary artery disease
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DOI：
10.4065/77.6.515
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发表时间：
2002-06-01
影响因子：
8.9
通讯作者：
Gibbons, RJ
中科院分区：
文献类型：
--
作者：
Ho, KT;Miller, TD;Gibbons, RJ
目的：为了确定简单的临床评分（之前已被证明可以预测转诊接受冠状动脉造影的患者患严重冠状动脉疾病（CAD）的可能性）是否可以预测静息心电图（ECG）正常或轻度异常的单独患者队列的预后，这些患者正在接受可能的CAD的无创评估。患者和方法：研究组包括2255例静息心电图正常（n=1466）或轻度异常（非特异性ST-T波异常; n=789）的有症状患者，这些患者在1989年至1991年期间接受运动铊试验。随访完成率为94%，平均+/-SD持续时间为6.9+/-1.5年。临床评分范围为0（最低风险）至10（最高风险），通过对男性、心肌梗死史、典型心绞痛、糖尿病、胰岛素使用和年龄大于40岁的每十年给予I分来计算。在每个ECG组中，临床评分是心源性死亡、非致死性心肌梗死或晚期血运重建的重要预测因子，单独或合并考虑，未调整或调整年龄。大多数患者的评分低于5分;这些患者的5年心脏存活率极佳（ECG正常组为99.7%，ST-T波异常组为98.8%）。评分高于5分的小部分患者的5年生存率要低得多（8%的ECG正常患者为92.3%，14%的ST-T波异常患者为86.6%）。对于5分的患者，5年生存率为97.7%的正常心电图结果组和95.9%的ST-T波abnormalities group.Conclusion：在有症状的患者已知或怀疑CAD和正常或轻度异常静息心电图结果，这种简单，易于计算的临床评分是一个有用的和有效的工具，以帮助确定预后。
Objective: To determine whether a simple clinical score, which was shown previously to predict the likelihood of severe coronary artery disease (CAD) in patients referred for coronary angiography, could predict prognosis in a separate cohort of patients with normal or mildly abnormal findings on their resting electrocardiogram (ECG) who were undergoing noninvasive evaluation for possible CAD.Patients and Methods: The study group included 2255 symptomatic patients with normal (n=1466) or mildly abnormal (nonspecific ST-T-wave abnormalities; n=789) findings on their resting ECG who were referred for exercise thallium testing between 1989 and 1991. Follow-up was 94% complete at a mean +/-SD duration of 6.9+/-1.5 years. The clinical score, which ranged from 0 (lowest risk) to 10 (highest risk), was calculated by awarding I point each for male sex, history of myocardial infarction, typical angina, diabetes mellitus, insulin use, and each decade of age older than 40 years.Results: In each ECG group, the clinical score was a significant predictor of cardiac death, nonfatal myocardial infarction, or late revascularization, considered individually or combined, unadjusted or with adjustment for age. Most patients had a score lower than 5; these patients had an excellent 5-year cardiac survival rate (99.7% for the normal ECG findings group and 98.8% for the ST-T-wave abnormalities group). The small subset of patients with a score higher than 5 had a much lower 5-year survival rate (92.3% for the 8% of patients with normal ECG findings and 86.6% for the 14% of patients with ST-T-wave abnormalities). For patients with a score of 5, the 5-year survival rate was 97.7% for the normal ECG findings group and 95.9% for the ST-T-wave abnormalities group.Conclusion: In symptomatic patients with known or suspected CAD and normal or mildly abnormal resting ECG findings, this simple, easily computed clinical score is a useful and valid tool to help determine prognosis.