Michaelides Andreas P, Andrikopoulos George K, Antoniades Charalambos, Soulis Dimitrios, Tzeis Stylianos, Hatzistamatiou Evangelos, Tzannos Konstantinos, Fourlas Christos, Seferlis Christos, Stefanadis Christodoulos I
First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
Coron Artery Dis. 2009 Aug;20(5):337-42. doi: 10.1097/MCA.0b013e32832c4589.
Total exercise duration and abnormal QRS score values are treadmill exercise testing (TET) prognostic parameters that have been shown to be significantly and independently associated with cardiac mortality. We evaluated the prognostic value of a new index (M score, Michaelides score) incorporating TET duration and QRS score values in a simple index.
In this study, we included 626 patients, who underwent TET and coronary arteriography. Cardiac catheterization showed the presence of coronary artery disease in 64.3% of these patients. The M score was calculated by adding the value of the Athens QRS score to the duration of TET (in minutes). The outcome measure was a composite of myocardial infarction or death. Patients were prospectively followed for 38+/-21 months (median 36 months).
The composite endpoint was more frequent among the patients of the 1st quartile (M-score values <-5.8). In univariate analysis, mortality of the first-quartile patients was significantly higher (14 vs. 1.1%, P<0.001). In multivariate Cox's regression analysis for age, sex, diabetes, smoking status, hypertension, hypercholesterolemia, maximum ST depression at TET, angina during TET, coronary artery disease on angiography, and echocardiographic left ventricular ejection fraction, the first quartile of M-score values was found to be independently associated with the composite endpoint (relative risk = 3.26, 95% confidence interval = 2.01-5.29, P<0.001).
This study shows that a new index termed the M score, which incorporates QRS score and exercise duration, predicts mortality and occurrence of myocardial infarction at long-term follow-up of high-risk individuals, independently of TET-induced ST-segment changes.
总运动持续时间和异常QRS评分值是平板运动试验（TET）的预后参数，已被证明与心脏死亡率显著且独立相关。我们评估了一个将TET持续时间和QRS评分值纳入一个简单指标的新指数（M评分，米凯莱德斯评分）的预后价值。
在本研究中，我们纳入了626例行TET和冠状动脉造影的患者。心脏导管检查显示这些患者中有64.3%存在冠状动脉疾病。M评分通过将雅典QRS评分值与TET持续时间（分钟）相加来计算。观察指标为心肌梗死或死亡的复合终点。对患者进行了38±21个月（中位数36个月）的前瞻性随访。
在第一四分位数（M评分值＜-5.8）的患者中，复合终点更为常见。在单因素分析中，第一四分位数患者的死亡率显著更高（14%对1.1%，P＜0.001）。在对年龄、性别、糖尿病、吸烟状况、高血压、高胆固醇血症、TET时最大ST段压低、TET时心绞痛、血管造影显示的冠状动脉疾病以及超声心动图左心室射血分数进行多因素Cox回归分析时，发现M评分值的第一四分位数与复合终点独立相关（相对风险 = 3.26，95%置信区间 = 2.01 - 5.29，P＜0.001）。
本研究表明，一个名为M评分的新指数，它纳入了QRS评分和运动持续时间，在对高危个体的长期随访中，可独立于TET诱导的ST段变化预测死亡率和心肌梗死的发生。
