Singh Mandeep, Gersh Bernard J, Li Shuang, Rumsfeld John S, Spertus John A, O'Brien Sean M, Suri Rakesh M, Peterson Eric D
Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Circulation. 2008 Jan 22;117(3):356-62. doi: 10.1161/CIRCULATIONAHA.107.711523. Epub 2008 Jan 2.
Current risk models predict in-hospital mortality after either coronary artery bypass graft surgery or percutaneous coronary interventions separately, yet the overlap suggests that the same variables can define the risks of alternative coronary reperfusion therapies. Our goal was to seek a preprocedure risk model that can predict in-hospital mortality after either percutaneous coronary intervention or coronary artery bypass graft surgery.
We tested the ability of the recently validated, integer-based Mayo Clinic Risk Score (MCRS) for percutaneous coronary intervention, which is based solely on preprocedure variables (age, creatinine, ejection fraction, myocardial infarction < or = 24 hours, shock, congestive heart failure, and peripheral vascular disease), to predict in-hospital mortality among 370,793 patients in the Society of Thoracic Surgeons database undergoing isolated coronary artery bypass graft surgery from 2004 to 2006. For the Society of Thoracic Surgeons coronary artery bypass graft surgery population studied, the median age was 66 years (quartiles 1 to 3, 57 to 74 years), with 37.2% of patients > or = 70 years old. A high prevalence of comorbid conditions, including diabetes mellitus (37.1%), hypertension (80.5%), peripheral vascular disease (15.3%), and renal disease (creatinine > or = 1.4 mg/dL; 11.8%), was present. A strong association existed between the MCRS and the observed mortality in the Society of Thoracic Surgeons database. The in-hospital mortality ranged between 0.3% (95% confidence interval 0.3% to 0.4%) with a score of 0 on the MCRS and 33.8% (95% confidence interval 27.3% to 40.3%) with an MCRS score of 20 to 24. The discriminatory ability of the MCRS was moderate, as measured by the area under the receiver operating characteristic curve (C-statistic = 0.715 to 0.784 among various subgroups); performance was inferior to the Society of Thoracic Surgeons model for most categories tested.
This model, which is based on 7 preprocedure risk variables, may be useful for providing patients with individualized, evidence-based estimates of procedural risk as part of the informed consent process before percutaneous or surgical revascularization.
目前的风险模型分别预测冠状动脉旁路移植术或经皮冠状动脉介入治疗后的住院死亡率，但二者存在重叠，这表明相同的变量可以界定不同冠状动脉再灌注治疗的风险。我们的目标是寻找一种术前风险模型，能够预测经皮冠状动脉介入治疗或冠状动脉旁路移植术后的住院死亡率。
我们测试了最近验证的、基于整数的梅奥诊所经皮冠状动脉介入治疗风险评分（MCRS）预测住院死亡率的能力，该评分仅基于术前变量（年龄、肌酐、射血分数、心肌梗死≤24小时、休克、充血性心力衰竭和外周血管疾病），对象为2004年至2006年在胸外科医师协会数据库中接受单纯冠状动脉旁路移植术的370,793例患者。对于所研究的胸外科医师协会冠状动脉旁路移植术人群，中位年龄为66岁（四分位数1至3，57至74岁），37.2%的患者年龄≥70岁。合并症的患病率较高，包括糖尿病（37.1%）、高血压（80.5%）、外周血管疾病（15.3%）和肾病（肌酐≥1.4mg/dL；11.8%）。MCRS与胸外科医师协会数据库中观察到的死亡率之间存在密切关联。MCRS评分为0时，住院死亡率在0.3%（95%置信区间0.3%至0.4%）之间；MCRS评分为20至24时，住院死亡率为33.8%（95%置信区间27.3%至40.3%）。根据受试者工作特征曲线下面积衡量，MCRS的鉴别能力中等（各亚组的C统计量为0.715至0.784）；在大多数测试类别中，其表现不如胸外科医师协会模型。
该基于7个术前风险变量的模型，可能有助于在经皮或外科血运重建术前的知情同意过程中，为患者提供个体化的、基于证据的手术风险评估。
