Angeli Fabio, Cavallini Claudio, Verdecchia Paolo, Morici Nuccia, Del Pinto Maurizio, Petronio Anna Sonia, Antonicelli Roberto, Murena Ernesto, Bossi Irene, De Servi Stefano, Savonitto Stefano
Dipartimento di Cardiologia, Ospedale S. M. Della Misericordia, Perugia, Italy.
Dipartimento di Cardiologia, Ospedale S. M. Della Misericordia, Perugia, Italy.
Am J Cardiol. 2015 Jul 15;116(2):208-13. doi: 10.1016/j.amjcard.2015.04.015. Epub 2015 Apr 18.
Approximately 1/3 of patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS) are ≥75 years of age. Risk stratification in these patients is generally difficult because supporting evidence is scarce. The investigators developed and validated a simple risk prediction score for 1-year mortality in patients ≥75 years of age presenting with NSTE ACS. The derivation cohort was the Italian Elderly ACS trial, which included 313 patients with NSTE ACS aged ≥75 years. A logistic regression model was developed to predict 1-year mortality. The validation cohort was a registry cohort of 332 patients with NSTE ACS meeting the same inclusion criteria as for the Italian Elderly ACS trial but excluded from the trial for any reason. The risk score included 5 statistically significant covariates: previous vascular event, hemoglobin level, estimated glomerular filtration rate, ischemic electrocardiographic changes, and elevated troponin level. The model allowed a maximum score of 6. The score demonstrated a good discriminating power (C statistic = 0.739) and calibration, even among subgroups defined by gender and age. When validated in the registry cohort, the scoring system confirmed a strong association with the risk for all-cause death. Moreover, a score ≥3 (the highest baseline risk group) identified a subset of patients with NSTE ACS most likely to benefit from an invasive approach. In conclusion, the risk for 1-year mortality in patients ≥75 years of age with NSTE ACS is substantial and can be predicted through a score that can be easily derived at the bedside at hospital presentation. The score may help in guiding treatment strategy.
约三分之一的非ST段抬高型（NSTE）急性冠状动脉综合征（ACS）患者年龄≥75岁。对这些患者进行风险分层通常很困难，因为支持证据稀少。研究人员针对年龄≥75岁的NSTE ACS患者开发并验证了一种简单的1年死亡率风险预测评分。推导队列来自意大利老年ACS试验，该试验纳入了313例年龄≥75岁的NSTE ACS患者。建立了一个逻辑回归模型来预测1年死亡率。验证队列是一个登记队列，包含332例符合与意大利老年ACS试验相同纳入标准但因任何原因被排除在该试验之外的NSTE ACS患者。风险评分包括5个具有统计学意义的协变量：既往血管事件、血红蛋白水平、估计肾小球滤过率、缺血性心电图改变和肌钙蛋白水平升高。该模型的最高评分为6分。该评分显示出良好的区分能力（C统计量 = 0.739）和校准能力，即使在按性别和年龄定义的亚组中也是如此。在登记队列中进行验证时，评分系统证实与全因死亡风险密切相关。此外，评分≥3分（基线风险最高组）确定了一组最有可能从侵入性治疗方法中获益的NSTE ACS患者。总之，年龄≥75岁的NSTE ACS患者1年死亡率风险很高，可通过在患者入院时床边轻松得出的评分进行预测。该评分可能有助于指导治疗策略。
