Brener Sorin J, Lincoff A Michael, Bates Eric R, Jia Gang, Armstrong Paul W, Guetta Victor, Hochman Judith S, Savonitto Stefano, Wilcox Robert G, White Harvey D, Topol Eric J
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Am Heart J. 2005 Jul;150(1):89-93. doi: 10.1016/j.ahj.2005.01.030.
We studied the potential interaction between baseline risk of death and treatment with either standard fibrinolytic monotherapy or combination fibrin and platelet lysis with respect to outcome of patients with ST-elevation myocardial infarction (STEMI) enrolled in the Global Utilization of Strategies To open Occluded arteries (GUSTO) V trial.
Using the Thrombolysis in Myocardial Infarction (TIMI) risk score (0-14 points) for STEMI, we analyzed the 30-day and 1-year mortality according to treatment assignment and risk category. Multivariable analysis was performed to identify the potential interactions between treatment and baseline risk.
The TIMI risk score could be calculated in 16256 patients (98% of patients enrolled). The median score was 2 (1-4) in each treatment group (P = .07). The risk score was significantly associated with 30-day mortality (hazard ratio [HR], 1.52; 95% CI 1.47-1.56, P < .001, for each additional 1 point), as well as with 1-year mortality (HR 1.51, CI 1.47-1.55, P < .001). The treatment allocation was not significantly related to mortality, and there was no significant interaction between baseline risk score and treatment with respect to either end point. Although combination therapy significantly reduced death or reinfarction at 7 days (HR 0.69, CI 0.54-0.89, P < .01), independent of the risk score, there was no significant statistical interaction between the two (P = .29).
The TIMI risk score accurately predicted early and 1-year mortality in patients with STEMI treated with pharmacological reperfusion. We did not identify any heterogeneity in the response of patients to combination therapy according to their TIMI risk score.
我们研究了在全球应用策略开通闭塞动脉（GUSTO）V试验中纳入的ST段抬高型心肌梗死（STEMI）患者的基线死亡风险与采用标准纤维蛋白溶解单药治疗或纤维蛋白与血小板联合溶解治疗之间的潜在相互作用对患者结局的影响。
使用STEMI的心肌梗死溶栓（TIMI）风险评分（0 - 14分），我们根据治疗分配和风险类别分析了30天和1年死亡率。进行多变量分析以确定治疗与基线风险之间的潜在相互作用。
16256例患者（占入组患者的98%）可计算TIMI风险评分。各治疗组的中位数评分为2（1 - 4）（P = 0.07）。风险评分与30天死亡率显著相关（风险比[HR]，1.52；95%可信区间1.47 - 1.56，P < 0.001，每增加1分），也与1年死亡率相关（HR 1.51，CI 1.47 - 1.55，P < 0.001）。治疗分配与死亡率无显著相关性，且基线风险评分与治疗在任何一个终点方面均无显著相互作用。尽管联合治疗在7天时显著降低了死亡或再梗死风险（HR 0.69，CI 0.54 - 0.89，P < 0.01），且与风险评分无关，但两者之间无显著统计学相互作用（P = 0.29）。
TIMI风险评分准确预测了接受药物再灌注治疗的STEMI患者的早期和1年死亡率。我们未发现患者根据其TIMI风险评分对联合治疗的反应存在任何异质性。
