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ST段抬高型心肌梗死患者死亡率的预测因素:一项前瞻性研究。

Predictors of mortality in ST-elevation MI patients: A prospective study.

作者信息

Zorbozan Onur, Cevik Arif A, Acar Nurdan, Ozakin Engin, Ozcelik Hamit, Birdane Alparslan, Abu-Zidan Fikri M

机构信息

Department of Emergency Medicine, Eskisehir Osmangazi University, College of Medicine and Health Sciences, Eskisehir, Turkey Departments of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates Department of Cardiology, Eskisehir Osmangazi University, College of Medicine and Health Sciences, Eskisehir, Turkey Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.

出版信息

Medicine (Baltimore). 2018 Mar;97(9):e0065. doi: 10.1097/MD.0000000000010065.

Abstract

We aimed to define factors predicting mortality in patients having ST elevation myocardial infarction (STEMI) who had Primary Percutaneous Coronary Intervention (PCI) in our setting.This is a prospective study on patients presenting to the emergency department with STEMI who underwent PCI during a 12-month period. Physiological parameters were calculated using the vital signs and age of patients. Time-based factors in the institutional protocol were collected. Univariate analysis was performed to define significant factors that affected mortality. Significant factors were then entered into a logistic regression model. Factors significantly affecting mortality were defined. Receiving operating characteristic curve was applied to define the best predictors of mortality.A total of 167 consecutive patients were studied; 128 (76.6%) were males. The mean (SD) age of the patients was 61.9 (12.8) years. The logistic regression model showed that significant factors were age (P = .002), Modified Shock Index, MSI (P = .028), systolic blood pressure (P = .028), and time between consultation and activation of catheter laboratory (P = .047). The cut-off points with best prediction of mortality were age of 71.5 years, systolic blood pressure of less than 95 mmHg, MSI of 0.85, and a time more than 3.5 minutes between consultation and activation of catheter laboratory.Our study shows that significant predictors of 30-days mortality of STEMI were age, systolic blood pressure on presentation, MSI, and the time between consultation and catheter laboratory activation. Improving prehospital resuscitation and activation of the catheter laboratory by emergency physicians may reduce mortality in our setting.

摘要

我们旨在确定在我们的医疗环境中接受直接经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死(STEMI)患者的死亡预测因素。这是一项针对在12个月期间因STEMI就诊于急诊科并接受PCI的患者的前瞻性研究。使用患者的生命体征和年龄计算生理参数。收集机构协议中的基于时间的因素。进行单因素分析以确定影响死亡率的显著因素。然后将显著因素纳入逻辑回归模型。确定显著影响死亡率的因素。应用接受操作特征曲线来确定死亡率的最佳预测因素。

共研究了167例连续患者;128例(76.6%)为男性。患者的平均(标准差)年龄为61.9(12.8)岁。逻辑回归模型显示,显著因素为年龄(P = 0.002)、改良休克指数(MSI,P = 0.028)、收缩压(P = 0.028)以及就诊至导管室启动的时间(P = 0.047)。死亡率最佳预测的切点为年龄71.5岁、收缩压低于95 mmHg、MSI为0.85以及就诊至导管室启动的时间超过3.5分钟。

我们的研究表明,STEMI患者30天死亡率的显著预测因素为年龄、就诊时的收缩压、MSI以及就诊至导管室启动的时间。急诊医生改善院前复苏和导管室启动可能会降低我们医疗环境中的死亡率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8246/5851714/47ed75c4e2ae/medi-97-e0065-g001.jpg

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