休克指数作为非ST段抬高型心肌梗死患者院内死亡率的预测指标
Shock Index as a predictor for In-hospital mortality in patients with non-ST-segment elevation myocardial infarction.
作者信息
Kobayashi Akihiro, Misumida Naoki, Luger Daniel, Kanei Yumiko
机构信息
Department of Internal Medicine, Mount Sinai Beth Israel, New York, USA.
Department of Internal Medicine, Mount Sinai Beth Israel, New York, USA.
出版信息
Cardiovasc Revasc Med. 2016 Jun;17(4):225-8. doi: 10.1016/j.carrev.2016.02.015. Epub 2016 Feb 27.
BACKGROUND/PURPOSE: Shock index (SI), a ratio of heart rate/systolic blood pressure, has been reported to predict increased mortality in patients with ST-segment elevation myocardial infarction. However, the prognostic value of SI has not been fully elucidated in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
METHODS/MATERIALS: We performed a retrospective analysis of 481 consecutive NSTEMI patients who underwent coronary angiography from January 2013 to June 2014. Systolic blood pressure and heart rate on presentation were recorded, and SI was calculated as heart rate/systolic blood pressure. Patients were divided into those with SI≧0.7 and those with SI<0.7. Baseline and angiographic characteristics were recorded. In addition, cardiogenic shock and in-hospital mortality were recorded and compared between the two groups.
RESULTS
Among 481 patients, 103 patients (21.4%) had SI≧0.7. No statistically significant difference was observed in baseline characteristics between the two groups. Patients with SI≧0.7 had a lower left ventricular ejection fraction than those with SI<0.7 (56 [35-60] % vs. 60 [45-64] %, p=0.035). Patients with SI≧0.7 had a higher rate of cardiogenic shock on admission (2.9% vs. 0.3%, p=0.032). Patients with SI≧0.7 had a higher, albeit statistically insignificant, incidence of cardiogenic shock after admission (5.0% vs. 1.9%, p=0.074). The total incidence of cardiogenic shock was higher in patients with SI≧0.7 (7.8% vs. 2.1%, p=0.001). Patients with SI≧0.7 had higher in-hospital mortality (4.9% vs. 0.5%, p=0.006) than those with SI<0.7.
CONCLUSION
Elevated SI was associated with higher in-hospital mortality in patients with NSTEMI.
背景/目的：休克指数（SI），即心率与收缩压之比，据报道可预测ST段抬高型心肌梗死患者死亡率的增加。然而，SI在非ST段抬高型心肌梗死（NSTEMI）患者中的预后价值尚未完全阐明。
方法/材料：我们对2013年1月至2014年6月期间连续481例行冠状动脉造影的NSTEMI患者进行了回顾性分析。记录就诊时的收缩压和心率，并计算SI（心率/收缩压）。患者分为SI≥0.7组和SI<0.7组。记录基线和血管造影特征。此外，记录两组的心源性休克和住院死亡率并进行比较。
结果
481例患者中，103例（21.4%）SI≥0.7。两组基线特征无统计学显著差异。SI≥0.7的患者左心室射血分数低于SI<0.7的患者（56[35 - 60]%对60[45 - 64]%，p = 0.035）。SI≥0.7的患者入院时心源性休克发生率较高（2.9%对0.3%，p = 0.032）。SI≥0.7的患者入院后心源性休克发生率虽无统计学显著差异，但也较高（5.0%对1.9%，p = 0.074）。SI≥0.7的患者心源性休克总发生率较高（7.8%对2.1%，p = 0.001）。SI≥0.7的患者住院死亡率高于SI<0.7的患者（4.9%对0.5%，p = 0.006）。
结论
NSTEMI患者中，SI升高与较高的住院死亡率相关。
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