Jain Jyoti, Narang Udit Ravinder, Jain Vishakha Vinay, Gupta Om P
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India.
Heart Views. 2013 Oct;14(4):171-8. doi: 10.4103/1995-705X.126882.
The electrocardiogram remains a crucial tool in identification of acute myocardial infarction (AMI). High sensitivity C-reactive protein (hs-CRP) has been found to be strong predictor of coronary artery disease (CAD) and future cardiovascular events.
The aim of the present study was to compare hs-CRP and ST-Score (STS) as prognostic indicator in acute ST segment elevated myocardial infarction (STEMI) in central rural India.
Cross sectional study, rural hospital in central India.
In all patients of STEMI, STS, ST index and hs-CRP were measured on admission and serially. The Primary outcome was all cause mortality at 30 days. Secondary outcome were heart failure, life threatening arrhythmia, cardiogenic shock, re-infarction, hospital stay and re-admission.
We used Student's t test to compare means, Chi-square test to compare proportions and Mann Whitney test to compare medians. P value <0.05 will be considered significant. Crude odds ratios were computed to assess the strength of association between risk factors and independent variable along with 95% confidence intervals.
STS was significantly higher in patients with poor outcome, when compared with good outcome (20.27mm vs.12.47mm, P = 0.002). On multivariate regression model STS was significant predictor of composite outcome events (OR = 2.74; 95% [CI], 1.46 to 5.17; P = 0.002). The area under the ROC curve was 0.70, with sensitivity of 73.5%, specificity of 58.7%; PPV of 68.3% and NPV of 64.2%. hs-CRP in patients with poor outcome vs. good outcome (6mg/L vs. 3.74mg/L, P = 0.003) and (P = 0.06, 0.85 and 0.12) respectively.
STS on admission is independent predictor while hs- CRP is not in resource constrained settings.
心电图仍然是识别急性心肌梗死（AMI）的关键工具。高敏C反应蛋白（hs-CRP）已被发现是冠状动脉疾病（CAD）和未来心血管事件的有力预测指标。
本研究的目的是比较hs-CRP和ST评分（STS）作为印度中部农村地区急性ST段抬高型心肌梗死（STEMI）预后指标的情况。
横断面研究，印度中部的农村医院。
对所有STEMI患者在入院时及随后连续测量STS、ST指数和hs-CRP。主要结局是30天全因死亡率。次要结局包括心力衰竭、危及生命的心律失常、心源性休克、再梗死、住院时间和再次入院。
我们使用学生t检验比较均值，卡方检验比较比例，曼-惠特尼检验比较中位数。P值<0.05将被视为具有统计学意义。计算粗比值比以评估危险因素与自变量之间关联的强度以及95%置信区间。
与预后良好的患者相比，预后不良的患者STS显著更高（20.27mm对12.47mm，P = 0.002）。在多变量回归模型中，STS是复合结局事件的显著预测指标（OR = 2.74；95%[CI]，1.46至5.17；P = 0.002）。ROC曲线下面积为0.70，敏感性为73.5%，特异性为58.7%；阳性预测值为68.3%，阴性预测值为64.2%。预后不良患者与预后良好患者的hs-CRP分别为（6mg/L对3.74mg/L，P = 0.003）以及（P = 0.06、0.85和0.12）。
在资源受限的环境中，入院时的STS是独立预测指标，而hs-CRP不是。
