Grupo de Estudio, Docencia e Investigación Clínica, Investigadores del Registro Epi-Cardio, Buenos Aires, Argentina.
Grupo de Estudio, Docencia e Investigación Clínica, Investigadores del Registro Epi-Cardio, Buenos Aires, Argentina.
Am J Cardiol. 2014 Jun 15;113(12):1956-61. doi: 10.1016/j.amjcard.2014.03.036. Epub 2014 Apr 1.
Observational studies have reported a marked discrepancy between the risk estimated by scores and the use of an invasive strategy in patients with acute coronary syndromes. The objective is to describe the criteria used to decide an early invasive strategy and to determine the differences between those criteria and the thrombolysis in myocardial infarction risk score (TRS). Patients entered to the Epi-Cardio registry with a diagnosis of non-ST-elevation acute coronary syndrome were analyzed. A logistic regression model including variables associated with an early invasive strategy was developed and validated in 2 consecutive cohorts. The association between the TRS and the clinical decision model with an early invasive strategy was evaluated by receiver operating characteristic (ROC) curves. We included a total of 3,187 patients. In the derivation cohort, variables associated with an early invasive strategy were previous angioplasty (odds ratio [OR] 1.63), hypercholesterolemia (OR 1.36), ST changes (OR 1.49), elevated biomarkers (OR 1.42), catheterization laboratory availability (OR 1.7), recurrent angina (OR 3.45), age (OR 0.98), previous coronary bypass (OR 0.65), previous heart failure (OR 0.40), and heart rate at admission (OR 0.98). The areas under the ROC curves to predict invasive strategy were 0.55 for the TRS and 0.69 for the clinical decision model, p <0.0001. In the validation cohort, ROC areas were 0.58 and 0.70, respectively, p <0.0001. In conclusion, invasive strategy was guided by variables not completely included in risk scores. The clinical, evolutionary, and structural variables included in the model can explain, partially, the discordance existing between risk stratification and medical strategies.
观察性研究报告称，在急性冠状动脉综合征患者中，评分估计的风险与侵入性策略的使用之间存在显著差异。目的是描述决定早期侵入性策略的标准，并确定这些标准与心肌梗死溶栓风险评分（TRS）之间的差异。对进入 Epi-Cardio 登记处的非 ST 段抬高型急性冠状动脉综合征患者进行了分析。建立了一个包含与早期侵入性策略相关的变量的逻辑回归模型，并在 2 个连续队列中进行了验证。通过接受者操作特征（ROC）曲线评估 TRS 与早期侵入性策略的临床决策模型之间的关系。共纳入 3187 例患者。在推导队列中，与早期侵入性策略相关的变量包括既往经皮冠状动脉介入治疗（比值比 [OR] 1.63）、高胆固醇血症（OR 1.36）、ST 段改变（OR 1.49）、升高的生物标志物（OR 1.42）、导管室可用性（OR 1.7）、复发性心绞痛（OR 3.45）、年龄（OR 0.98）、既往冠状动脉旁路移植术（OR 0.65）、既往心力衰竭（OR 0.40）和入院时心率（OR 0.98）。TRS 预测侵入性策略的 ROC 曲线下面积为 0.55，临床决策模型为 0.69，p<0.0001。在验证队列中，ROC 曲线下面积分别为 0.58 和 0.70，p<0.0001。总之，侵入性策略是由不完全包含在风险评分中的变量指导的。模型中包含的临床、进化和结构变量可以部分解释风险分层和医疗策略之间存在的差异。
