Zuin Marco, Rigatelli Gianluca, Picariello Claudio, Carraro Mauro, Zonzin Pietro, Roncon Loris
Department of Cardiology, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, 45100, Rovigo, Italy.
Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy.
Heart Vessels. 2017 Dec;32(12):1478-1487. doi: 10.1007/s00380-017-1012-5. Epub 2017 Jun 22.
Acute pulmonary embolism (PE) is the third cause of cardiovascular (CV) mortality. We evaluated a new risk index, named Age-Mean Arterial Pressure Index (AMAPI), to predict 30-day CV mortality in patients with acute PE. Data of 209 patients (44.0% male and 56.0% female, mean age 70.58 ± 14.14 years) with confirmed acute PE were retrospectively analysed. AMAPI was calculated as the ratio between age and mean arterial pressure (MAP), which was defined as [systolic blood pressure + (2 × diastolic blood pressure)]/3. To test AMAPI accuracy, a comparison with shock index (SI) and simplified pulmonary embolism severity index (sPESI) was performed. Patients were divided in two groups according their hemodynamic stability, or not, at admission. 30-day mortality rate, in all cases for CV events, was 10.5% (n = 22). Hemodynamically unstable patients had a higher AMAPI compare to those without hypotension at admission (1.28 ± 0.39 vs 0.78 ± 0.27, p < 0.0001). Receiving operative curve analyses (ROC) found the optimal cut-off for AMAPI in hemodynamically stable and unstable patients ≥0.9 and ≥0.92, respectively. In both groups, patients with an AMAPI over the cut-off were significantly older, hypotensive (both systolic and diastolic blood pressure), with a higher SI and lower MAP. In hemodynamically stable patients, 30-day CV mortality risk prediction was improved adding AMAPI ≥0.9 to both SI and sPESI (net reclassification improvement-NRI-of 14.2%, p = 0.0006 and 11.5%, p = 0.0002, respectively). In hemodynamically unstable patients NRI was 19.2%, p = 0.006. Mantel-Cox analysis revealed a statistical significant difference in the distribution of survival between hemodynamically stable patients with an AMAPI index ≥0.9 compared to those with an AMAPI <0.89 [log rank (Mantel-Cox) p < 0.0001] and in hemodynamically unstable patients with an AMAPI ≥0.92 [log rank (Mantel-Cox) p = 0.001]. AMAPI ≥0.90 and ≥0.92 predict 30-day CV mortality in hemodynamically stable and unstable patients with acute PE.
急性肺栓塞（PE）是心血管（CV）疾病死亡的第三大原因。我们评估了一种名为年龄-平均动脉压指数（AMAPI）的新风险指数，以预测急性PE患者30天的CV死亡率。对209例确诊为急性PE的患者（男性44.0%，女性56.0%，平均年龄70.58±14.14岁）的数据进行了回顾性分析。AMAPI计算为年龄与平均动脉压（MAP）之比，MAP定义为[收缩压 +（2×舒张压）]/3。为了测试AMAPI的准确性，将其与休克指数（SI）和简化肺栓塞严重程度指数（sPESI）进行了比较。根据患者入院时的血流动力学稳定性将其分为两组。所有CV事件病例的30天死亡率为10.5%（n = 22）。血流动力学不稳定的患者与入院时无低血压的患者相比，AMAPI更高（1.28±0.39 vs 0.78±0.27，p < ）。接受性曲线分析（ROC）发现，血流动力学稳定和不稳定患者中AMAPI的最佳截断值分别≥0.9和≥0.92。在两组中，AMAPI超过截断值的患者年龄显著更大，有低血压（收缩压和舒张压均低），SI更高，MAP更低。在血流动力学稳定的患者中，将AMAPI≥0.9添加到SI和sPESI中可改善30天CV死亡风险预测（净重新分类改善-NRI-分别为14.2%，p = 0.0006和11.5%，p = 0.0002）。在血流动力学不稳定的患者中，NRI为19.2%，p = 0.006。Mantel-Cox分析显示，AMAPI指数≥0.9的血流动力学稳定患者与AMAPI<0.89的患者相比，生存分布存在统计学显著差异[对数秩（Mantel-Cox）p < 0.0001]，AMAPI≥0.92的血流动力学不稳定患者也存在显著差异[对数秩（Mantel-Cox）p = 0.001]。AMAPI≥0.90和≥0.92可预测急性PE血流动力学稳定和不稳定患者的30天CV死亡率。 0001
