Chen Chien-Chih, Chong Chee-Fah, Kuo Cheng-Deng, Wang Tzong-Luen
Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
Am J Emerg Med. 2007 May;25(4):406-13. doi: 10.1016/j.ajem.2006.09.009.
Silent myocardial ischemia (SMI) is a relatively common complication in patients with coronary artery disease (CAD) under aspirin therapy presenting with upper gastrointestinal hemorrhage (UGIH).
This study was conducted to develop and prospectively validate a risk prediction score to identify SMI in patients undergoing aspirin therapy for CAD presenting with UGIH in the emergency department (ED).
This was a 2-phase noninterventional study. In the derivation phase, adults with CAD under aspirin therapy (100 mg once daily) presenting to the ED with UGIH were retrospectively recruited. By multiple logistic regression analysis, we derived a risk score from 224 patients that predicts the patients' risk of SMI. In the validation phase, we prospectively validated this score using receiver operating characteristic curves with data from 110 patients. We also developed a fast-track screening procedure from this score.
There were 56 patients (25.0%) and 29 patients (26.4%) with SMI in the derivation and validation sets, respectively. Independent multivariate predictors of SMI were age of older than 75 years, severity of CAD, systolic blood pressure of less than 110 mm Hg, diastolic blood pressure of less than 85 mm Hg, hematocrit of less than 30%, and blood urea nitrogen-creatinine ratio of more than 30. The area under receiver operating characteristic curve for the rule was 0.93 in the derivation set and 0.96 in the validation set. At the cutoff value of 5 points or higher, the sensitivity and specificity of the fast-track screening procedure for SMI were 96.6% and 86.4%, respectively. The positive and negative predictive values were 71.8% and 98.6%, respectively.
This simple risk prediction score is easily calculated and is based on rapidly available clinical and laboratory data in the ED. It can be used to stratify patients undergoing aspirin therapy for CAD presenting with UGIH by risk of SMI.
无症状心肌缺血（SMI）是冠状动脉疾病（CAD）患者在接受阿司匹林治疗时出现上消化道出血（UGIH）的一种相对常见的并发症。
本研究旨在开发并前瞻性验证一种风险预测评分，以识别在急诊科（ED）因CAD接受阿司匹林治疗且出现UGIH的患者中的SMI。
这是一项两阶段的非干预性研究。在推导阶段，回顾性招募了因UGIH就诊于ED且正在接受阿司匹林治疗（每日一次，100毫克）的CAD成年患者。通过多因素逻辑回归分析，我们从224例患者中得出了一个预测SMI风险的评分。在验证阶段，我们使用110例患者的数据通过受试者操作特征曲线对该评分进行前瞻性验证。我们还根据该评分制定了快速筛查程序。
推导集和验证集中分别有56例（25.0%）和29例（26.4%）患者发生SMI。SMI的独立多因素预测因素包括年龄大于75岁、CAD严重程度、收缩压低于110毫米汞柱、舒张压低于85毫米汞柱、血细胞比容低于30%以及血尿素氮-肌酐比值大于30。该规则在推导集中受试者操作特征曲线下面积为0.93，在验证集中为0.96。在截断值为5分或更高时，SMI快速筛查程序的敏感性和特异性分别为96.6%和86.4%。阳性和阴性预测值分别为71.8%和98.6%。
这种简单的风险预测评分易于计算，且基于ED中快速可得的临床和实验室数据。它可用于根据SMI风险对因CAD接受阿司匹林治疗且出现UGIH的患者进行分层。
