Grunau Gilat L, Sheps Sam, Goldner Elliot M, Ratner Pamela A
Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada.
J Clin Epidemiol. 2006 Mar;59(3):274-80. doi: 10.1016/j.jclinepi.2005.08.007.
To compare methods of risk adjustment in a population of individuals with acute myocardial infarction (AMI), in order to assist clinicians in assessing patient prognosis.
A historical inception cohort design was established, with follow-up of <or=5 years. A province-wide population-based administrative dataset from British Columbia, Canada, was used to select the cohort and construct variables. All individuals aged >or=66 years who had an AMI in 1994 or 1995 were selected (n = 4,874). The three risk-adjustment methods were the Ontario AMI prediction rule (OAMIPR), the D'Hoore adaptation of the Charlson Index, and the total number of distinct comorbidities. Logistic regression models were built including each of the adjustment methods, age, sex, socioeconomic status, previous AMI, and cardiac procedures at time of AMI.
The OAMIPR had the highest C-statistic and R(2).
Clinicians are advised to consider the specific comorbidities that are present, not merely their number, and those that emerge over time, not merely those present at the time of the infarct.
比较急性心肌梗死（AMI）患者群体中风险调整的方法，以协助临床医生评估患者预后。
采用历史队列起始设计，随访时间≤5年。利用加拿大不列颠哥伦比亚省基于全省人口的行政数据集来选择队列并构建变量。选取了1994年或1995年发生AMI且年龄≥66岁的所有个体（n = 4874）。三种风险调整方法分别是安大略省AMI预测规则（OAMIPR）、查尔森指数的德胡尔改编版以及不同共病的总数。构建了逻辑回归模型，纳入了每种调整方法、年龄、性别、社会经济地位、既往AMI以及AMI时的心脏手术。
OAMIPR的C统计量和R²最高。
建议临床医生考虑存在的特定共病，而不仅仅是其数量，以及随时间出现的共病，而不仅仅是梗死时存在的共病。
