Huang Bi, Yang Yanmin, Zhu Jun, Liang Yan, Tan Huiqiong, Yu Litian, Gao Xin, Li Jiandong
State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Am J Cardiol. 2014 Nov 1;114(9):1315-21. doi: 10.1016/j.amjcard.2014.07.062. Epub 2014 Aug 12.
Current risk scores of ST-segment elevation myocardial infarction (STEMI) need sophisticated algorithm and were limited for bedside use. Our study aimed to evaluate the usefulness of admission shock index (SI) for predicting the short-term outcomes in patients with STEMI. Included were 7,187 consecutive patients with STEMI. The admission SI was defined as the ratio of admission heart rate and systolic blood pressure. Patients were divided into 2 groups with SI <0.7 and ≥0.7, respectively, based on the receiver operating characteristic curve analysis. The major end points were 7- and 30-day all-cause mortality. Of 7,187 patients, 5,026 had admission SI <0.7 and 2,161 had admission SI ≥0.7. Those who presented with SI ≥0.7 had greater 7- and 30-day all-cause mortality and major adverse cardiovascular events than patients with SI <0.7. After multivariate adjustment, patients with SI ≥0.7 had a 2.2-fold increased risk of 7-day all-cause mortality (hazard ratio 2.21, 95% confidence interval [CI] 1.71 to 2.86) and 1.9-fold increased risk of 30-day all-cause mortality (hazard ratio 1.94, 95% CI 1.54 to 2.44). Moreover, admission SI ≥0.7 was also associated with 1.6- and 1.5-fold increased risk of 7- and 30-day major adverse cardiovascular events (hazard ratio 1.63, 95% CI 1.36 to 1.95 and hazard ratio 1.47, 95% CI 1.24 to 1.74, respectively). The C statistic of admission SI for predicting 7- and 30-day all-cause mortality was 0.701 and 0.686, respectively, compared with 0.744 and 0.738 from the Thrombolysis In Myocardial Infarction risk score. In conclusion, admission SI, an easily calculated index at first contact, may be a useful predictor for short-term outcomes especially for acute phase outcomes in patients with STEMI.
目前，ST段抬高型心肌梗死（STEMI）的风险评分需要复杂的算法，且在床边使用时存在局限性。我们的研究旨在评估入院时的休克指数（SI）对预测STEMI患者短期预后的有效性。纳入了7187例连续的STEMI患者。入院时的SI定义为入院心率与收缩压之比。根据受试者工作特征曲线分析，患者分别被分为SI<0.7和≥0.7的两组。主要终点为7天和30天的全因死亡率。在7187例患者中，5026例入院时SI<0.7，2161例入院时SI≥0.7。与SI<0.7的患者相比，SI≥0.7的患者7天和30天的全因死亡率以及主要不良心血管事件更高。经过多变量调整后，SI≥0.7的患者7天全因死亡风险增加2.2倍（风险比2.21，95%置信区间[CI]为1.71至2.86），30天全因死亡风险增加1.9倍（风险比1.94，95%CI为1.54至2.44）。此外，入院时SI≥0.7还与7天和30天主要不良心血管事件风险分别增加1.6倍和1.5倍相关（风险比分别为1.63，95%CI为1.36至1.95；风险比1.47，95%CI为1.24至1.74）。入院时SI预测7天和30天全因死亡率的C统计量分别为0.701和0.686，而心肌梗死溶栓风险评分的C统计量分别为0.744和0.738。总之，入院时的SI是首次接触时易于计算的指标，可能是预测STEMI患者短期预后尤其是急性期预后的有用指标。
