经过验证的风险评分可预测不稳定型心绞痛或非ST段抬高型心肌梗死后充血性心力衰竭的发生：来自OPUS-TIMI 16和TACTICS-TIMI 18的结果。

Validated risk score predicts the development of congestive heart failure after presentation with unstable angina or non-ST-elevation myocardial infarction: results from OPUS-TIMI 16 and TACTICS-TIMI 18.

作者信息

Wylie John V, Murphy Sabina A, Morrow David A, de Lemos James A, Antman Elliott M, Cannon Christopher P

机构信息

Division of Cardiology, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Mass 02215, USA.

出版信息

Am Heart J. 2004 Jul;148(1):173-80. doi: 10.1016/j.ahj.2003.12.018.

DOI:10.1016/j.ahj.2003.12.018

PMID:15215808

Abstract

BACKGROUND

Few data are available about development of congestive heart failure (CHF) in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI). We developed and validated a risk score to predict which patients will develop CHF.

METHODS

A subset of 4681 patients from the Orbofiban in Patients With Unstable Coronary Syndromes-Thrombolysis in Myocardial Infarction (OPUS-TIMI 16) trial with UA/NSTEMI and without a history of CHF were included in this analysis and stratified according to the development of CHF at 10 months. A risk score was created from significant variables and validated in the Treat Angina With Aggrastat and Determine Cost of Therapy With an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction (TACTICS-TIMI 18) trial. B-type natriuretic peptide (BNP) was then added to the initial multivariate analysis and validated in the TACTICS-TIMI 18 trial.

RESULTS

The incidence of CHF at 30 days was 4.9%, and at 10 months it was 5.6%. Significant variables on multivariate analysis included age >65 years, heart rate >100 beats/min, history of diabetes mellitus, lateral electrocardiographic changes, and history of angiographically confirmed coronary artery disease. The risk of CHF increased 10-fold across the number of risk factors (P <.001). When validated in the TACTICS-TIMI 18 trial, the risk score was significantly associated with CHF at 6 months (P =.01). The median BNP value doubled across the number of risk factors (P <.001 for trend). The addition of BNP to the risk score improved its discriminatory capacity.

CONCLUSIONS

In patients with UA/NSTEMI, a simple clinical risk score can aid in assessing the risk of developing CHF. BNP adds to the predictive capacity of this risk score. This score may assist in identifying patients who warrant more careful monitoring and therapy for CHF prevention inhospital and during follow-up.

摘要

背景

关于不稳定型心绞痛/非ST段抬高型心肌梗死（UA/NSTEMI）患者发生充血性心力衰竭（CHF）的数据较少。我们开发并验证了一种风险评分，以预测哪些患者会发生CHF。

方法

本分析纳入了不稳定冠状动脉综合征患者使用orbofiban-心肌梗死溶栓治疗（OPUS-TIMI 16）试验中的4681例UA/NSTEMI且无CHF病史的患者子集，并根据10个月时CHF的发生情况进行分层。从显著变量创建风险评分，并在阿昔单抗治疗心绞痛和确定侵入性或保守策略治疗成本-心肌梗死溶栓治疗（TACTICS-TIMI 18）试验中进行验证。然后将B型利钠肽（BNP）添加到初始多变量分析中，并在TACTICS-TIMI 18试验中进行验证。

结果

30天时CHF的发生率为4.9%，10个月时为5.6%。多变量分析中的显著变量包括年龄>65岁、心率>100次/分钟、糖尿病史、心电图侧方改变以及血管造影证实的冠状动脉疾病史。CHF风险随着风险因素数量增加10倍（P<.001）。在TACTICS-TIMI 18试验中进行验证时，风险评分与6个月时的CHF显著相关（P=.01）。BNP中位数在风险因素数量范围内翻倍（趋势P<.001）。将BNP添加到风险评分中可提高其鉴别能力。