一种用于预测急性冠状动脉综合征患者一年死亡率的姑息治疗工具的前瞻性评估。

Prospective assessment of a palliative care tool to predict one-year mortality in patients with acute coronary syndrome.

作者信息

Moretti Claudio, Iqbal Javaid, Murray Scott, Bertaina Maurizio, Parviz Yasir, Fenning Stephen, Quadri Giorgio, Gunn Julian, D'Ascenzo Fabrizio, Marra Sebastiano, Moiraghi Corrado, Riccardini Franco, Veglio Franco, Gaita Fiorenzo, Denvir Martin

机构信息

1 Città della Salute e della Scienza, Italy.

2 South Yorkshire Cardiothoracic Centre, Northern General Hospital, UK.

出版信息

Eur Heart J Acute Cardiovasc Care. 2017 Apr;6(3):272-279. doi: 10.1177/2048872616633841. Epub 2016 Feb 15.

DOI:10.1177/2048872616633841

PMID:26880851

Abstract

BACKGROUND

Identifying patients with acute coronary syndrome (ACS) who are approaching the end of life and who may not benefit from an aggressive interventional approach is important but clinically challenging. The Gold Standards Framework (GSF) prognostic guide was developed using multidimensional criteria to identify cancer patients who could benefit from end-of-life care. We assessed the utility of the GSF to predict one-year mortality in ACS patients.

METHODS

ACS patients admitted between May 2012 and July 2013 at the three participating cardiac centres in Europe were enrolled. Patients were assessed during admission using the GSF, the Global Registry of Acute Coronary Events (GRACE) score, the age, creatinine, ejection fraction (ACEF) score and the New York Percutaneous Coronary Intervention (NY-PCI) risk score. The pre-specified primary outcome was all-cause mortality at one year; secondary outcomes were cardiovascular death, non-cardiovascular mortality, re-hospitalisation for ACS and re-hospitalisation for non-ACS causes.

RESULTS

Six hundred and twenty-nine ACS patients were enrolled and one-year follow-up data was available for 626 patients. Fifty-two patients (8.3%) met GSF criteria for end-of-life care. These patients were older, predominantly female, had lower body mass index (BMI), and were less likely to receive angiography (75% vs 95%, p<0.001) and angioplasty (60% vs 77%, p=0.005) compared with patients who did not meet GSF criteria. Patients meeting GSF criteria had higher one-year all-cause mortality (42.3% vs 4.5%, p<0.001), cardiovascular mortality (15.4% vs 2.8%, p<0.001) and non-cardiovascular mortality (26.9% vs 1.7%; p<0.001). Multivariate analysis confirmed that meeting GSF criteria independently predicted all-cause mortality.

CONCLUSION

GSF is a multidimensional tool which may be used to identify ACS patients that are at high risk of death and may benefit from end-of-life care.

摘要

背景

识别那些已接近生命末期且可能无法从积极介入治疗方法中获益的急性冠状动脉综合征（ACS）患者很重要，但在临床上具有挑战性。黄金标准框架（GSF）预后指南是使用多维标准制定的，用于识别可从临终关怀中获益的癌症患者。我们评估了GSF预测ACS患者一年死亡率的效用。

方法

纳入2012年5月至2013年7月期间在欧洲三个参与研究的心脏中心收治的ACS患者。在入院期间使用GSF、急性冠状动脉事件全球注册（GRACE）评分、年龄、肌酐、射血分数（ACEF）评分和纽约经皮冠状动脉介入治疗（NY-PCI）风险评分对患者进行评估。预先设定的主要结局是一年时的全因死亡率；次要结局是心血管死亡、非心血管死亡、因ACS再次住院和因非ACS原因再次住院。

结果

共纳入629例ACS患者，626例患者有一年的随访数据。52例患者（8.3%）符合GSF临终关怀标准。与不符合GSF标准的患者相比，这些患者年龄更大，以女性为主，体重指数（BMI）更低，接受血管造影（75%对95%，p<0.001）和血管成形术（60%对77%，p=0.005）的可能性更小。符合GSF标准的患者一年全因死亡率更高（42.3%对4.5%，p<0.001），心血管死亡率更高（15.4%对2.8%，p<0.001），非心血管死亡率更高（26.9%对1.7%；p<0.001）。多变量分析证实，符合GSF标准可独立预测全因死亡率。