Yanishi Kenji, Nakamura Takeshi, Nakanishi Naohiko, Yokota Isao, Zen Kan, Yamano Tetsuhiro, Shiraishi Hirokazu, Shirayama Takeshi, Shiraishi Jun, Sawada Takahisa, Kohno Yoshio, Kitamura Makoto, Furukawa Keizo, Matoba Satoaki
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
PLoS One. 2016 Nov 11;11(11):e0166391. doi: 10.1371/journal.pone.0166391. eCollection 2016.
Many mortality risk scoring tools exist among patients with ST-elevation Myocardial Infarction (STEMI). A risk stratification model that evaluates STEMI prognosis more simply and rapidly is preferred in clinical practice.
We developed a simple stratification model for blood examination by using the STEMI data of AMI-Kyoto registry in the derivation set (n = 1,060) and assessed its utility for mortality prediction in the validation set (n = 521). We selected five variables that significantly worsen in-hospital mortality: white blood cell count, hemoglobin, C-reactive protein, creatinine, and blood sugar levels at >10,000/μL, <10 g/dL, >1.0 mg/dL, >1.0 mg/dL, and >200 mg/dL, respectively. In the derivation set, each of the five variables significantly worsened in-hospital mortality (p < 0.01). We developed the risk stratification model by combining laboratory variables that were scored based on each beta coefficient obtained using multivariate analysis and divided three laboratory groups. We also found a significant trend in the in-hospital mortality rate for three laboratory groups. Therefore, we assessed the utility of this model in the validation set. The prognostic discriminatory capacity of our laboratory stratification model was comparable to that of the full multivariable model (c-statistic: derivation set vs validation set, 0.81 vs 0.74). In addition, we divided all cases (n = 1,581) into three thrombolysis in myocardial infarction (TIMI) risk index groups based on an In TIME II substudy; the cases were further subdivided based on this laboratory model. The high laboratory group had significantly high in-hospital mortality rate in each TIMI risk index group (trend of in-hospital mortality; p < 0.01).
This laboratory stratification model can predict in-hospital mortality of STEMI simply and rapidly and might be useful for predicting in-hospital mortality of STEMI by further subdividing the TIMI risk index.
ST段抬高型心肌梗死（STEMI）患者中存在多种死亡风险评分工具。临床实践中更倾向于一种能更简单快速评估STEMI预后的风险分层模型。
我们利用AMI - 京都注册研究的STEMI数据在推导集（n = 1060）中开发了一种用于血液检查的简单分层模型，并在验证集（n = 521）中评估其对死亡率预测的效用。我们选择了五个与院内死亡率显著相关的变量：白细胞计数、血红蛋白、C反应蛋白、肌酐以及血糖水平，分别对应>10000/μL、<10 g/dL、>1.0 mg/dL、>1.0 mg/dL和>200 mg/dL。在推导集中，这五个变量中的每一个都显著增加了院内死亡率（p < 0.01）。我们通过结合基于多变量分析获得的每个β系数进行评分的实验室变量来开发风险分层模型，并将其分为三个实验室组。我们还发现三个实验室组的院内死亡率存在显著趋势。因此，我们在验证集中评估了该模型的效用。我们的实验室分层模型的预后判别能力与全多变量模型相当（c统计量：推导集与验证集，0.81对0.74）。此外，我们根据In TIME II子研究将所有病例（n = 1581）分为三个心肌梗死溶栓（TIMI）风险指数组；这些病例再根据该实验室模型进一步细分。在每个TIMI风险指数组中，高实验室组的院内死亡率均显著较高（院内死亡率趋势；p < 0.01）。
这种实验室分层模型能够简单快速地预测STEMI患者的院内死亡率，并且通过进一步细分TIMI风险指数可能有助于预测STEMI患者的院内死亡率。
