Khan S Q, Quinn P, Davies J E, Ng L L
University of Leicester, Department of Cardiovascular Sciences, Leicester Royal Infirmary, Leicester, UK.
Heart. 2008 Jan;94(1):40-3. doi: 10.1136/hrt.2006.108985. Epub 2007 May 8.
The TIMI risk score is a well-validated scoring system used to predict mortality in patients following an ST-segment elevation myocardial infarction (STEMI). N-terminal pro-B-type natriuretic peptide (NTproBNP) has also been found to be useful in predicting mortality following STEMI.
To investigate the utility of the TIMI score and NTproBNP levels at predicting risk of death in patients with acute myocardial infarction (AMI).
473 patients (352 men, mean (SD) age 63.7 (12.3) years) with AMI were studied. Blood was drawn within 24 hours after the onset of chest pain and the plasma concentration of NTproBNP was determined using an in-house non-competitive immunoassay. Patients' TIMI risk score was measured and patients stratified into low- (0 to 2), intermediate- (3-7) and high-risk (>8) groups.
Mortality was 8.9% and was related to higher TIMI risk scores (p = 0.029 for trend). Higher NTproBNP levels were also related to increased mortality (median (range) fmol/ml, survivors 700.2 (0.3-11485.3) vs dead 5781.3 (1.4-10835.9), p<0.001). In a multivariate binary logistic regression model, independent predictors of mortality were NTproBNP levels in the first 24 hours (odds ratio (OR) = 4.21, 95% CI 1.96 to 9.07, p<0.001) together with drug treatments. The receiver operating curve for NTproBNP in the first 24 hours yielded an area under the curve (AUC) of 0.79 (95% CI 0.70 to 0.88), p<0.001, for TIMI risk score the AUC was 0.67 (95% CI 0.58 to 0.76), p = 0.001.
In the first 24 hours following an AMI, NTproBNP is better than the TIMI risk score at predicting mortality. A simple NTproBNP blood test is more easily applicable and is more accurate than a clinical risk score.
心肌梗死溶栓治疗（TIMI）风险评分是一种经过充分验证的评分系统，用于预测ST段抬高型心肌梗死（STEMI）患者的死亡率。N端前脑钠肽（NTproBNP）也被发现可用于预测STEMI后的死亡率。
探讨TIMI评分和NTproBNP水平在预测急性心肌梗死（AMI）患者死亡风险中的作用。
对473例AMI患者（352例男性，平均（标准差）年龄63.7（12.3）岁）进行研究。在胸痛发作后24小时内采血，采用内部非竞争性免疫分析法测定血浆NTproBNP浓度。测量患者的TIMI风险评分，并将患者分为低风险（0至2分）、中风险（3 - 7分）和高风险（>8分）组。
死亡率为8.9%，且与较高的TIMI风险评分相关（趋势p = 0.029）。较高的NTproBNP水平也与死亡率增加相关（中位数（范围）fmol/ml，存活者700.2（0.3 - 11485.3）对死亡者5781.3（1.4 - 10835.9），p<0.001）。在多变量二元逻辑回归模型中，死亡的独立预测因素是最初24小时内的NTproBNP水平（比值比（OR） = 4.21，95%置信区间1.96至9.07，p<0.001）以及药物治疗。最初24小时内NTproBNP的受试者工作特征曲线下面积（AUC）为0.79（95%置信区间0.70至0.88），p<0.001，TIMI风险评分的AUC为0.67（95%置信区间0.58至0.76），p = 0.001。
在AMI后的最初24小时内，NTproBNP在预测死亡率方面优于TIMI风险评分。简单的NTproBNP血液检测比临床风险评分更易于应用且更准确。
