Lakkireddy Dhanunjaya, Vacek James, Harris William, Gowda Manohar, Pendyala Kaushalya, Murray Caroline
Mid America Cardiology at University of Kansas Medical Center, Kansas City, KS, USA.
Med Sci Monit. 2005 Mar;11(3):CR95-9.
Prediction of long-term outcomes for patients presenting with cardiac events is important, but few predictive instruments are available. We previously developed an innovative scoring system, the Mid America Heart Institute (MAHI) Coronary Care Unit (CCU) scoring system, for quantifying outcomes of patients admitted to the CCU, using clinical events rather than solely physiologic and laboratory variables. The objective of our study was to validate a refined version of this system (MAHI-2) and to explore its prognostic value, we have postulated that patients with high MAHI scores would have higher mortality and morbidity in 1-year follow-up.
MATERIAL/METHODS: 154 patients admitted to the CCU were followed and assigned a MAHI score based on key clinical variables and events. The patients were followed for 1 year and outcomes were analyzed based on MAHI score quartiles.
The mean MAHI-2 score was 14+/-8. Over one year, 34 patients died, 13 suffered myocardial infarction, 12 had coronary artery bypass graft, 6 had percutaneous transluminal coronary angiography, 37 had a cardiovascular-related admission, and a total of 48 (31%) suffered >1 major adverse cardiac event (MACE - death/myocardial infarction/revascularization). MACE rates increased progressively by MAHI-2 score quartile (from 21% for those in the lowest quartile, to 42% in the highest quartile; p=0.22). The risk of death was more strongly correlated with MAHI-2 score, with patients in the highest quartile being at 6-fold greater risk for death in 1 year than those in the lowest quartile (p<0.0017).
The MAHI-2 score appears to be a useful tool for predicting 1-year clinical outcomes based on in-hospital events.
预测出现心脏事件的患者的长期预后很重要，但可用的预测工具很少。我们之前开发了一种创新的评分系统，即美国中西部心脏研究所（MAHI）冠心病监护病房（CCU）评分系统，用于量化入住CCU患者的预后，该系统使用临床事件而非仅仅生理和实验室变量。我们研究的目的是验证该系统的改进版本（MAHI-2）并探讨其预后价值，我们推测MAHI评分高的患者在1年随访中会有更高的死亡率和发病率。
材料/方法：对154名入住CCU的患者进行随访，并根据关键临床变量和事件为其分配MAHI评分。对患者进行了1年的随访，并根据MAHI评分四分位数分析结果。
MAHI-2评分的平均值为14±8。在一年时间里，34名患者死亡，13名发生心肌梗死，12名接受冠状动脉搭桥手术，6名接受经皮腔内冠状动脉血管成形术，37名因心血管相关疾病入院，共有48名（31%）患者发生>1次主要不良心脏事件（MACE——死亡/心肌梗死/血运重建）。MACE发生率随着MAHI-2评分四分位数逐渐增加（从最低四分位数的21%增至最高四分位数的42%；p = 0.22）。死亡风险与MAHI-2评分的相关性更强，最高四分位数的患者在1年内死亡风险是最低四分位数患者的6倍（p<0.0017）。
MAHI-2评分似乎是一种基于住院事件预测1年临床结局的有用工具。
