Ikram Sohail, Pachika Ajay, Schuster Henrike, Ghotra Aman, Dotson Laura, Akbar Shoaib, Khan Abdur Rahman
From the Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, Kentucky.
South Med J. 2018 Apr;111(4):226-229. doi: 10.14423/SMJ.0000000000000785.
The objective of this study was to identify risk factors and clinical profile of the patients presenting with ST elevation myocardial infarction (STEMI). We further evaluated the utility of the Framingham Risk Score (FRS) in the accurate identification of these patients if used before their coronary event.
We evaluated the demographic, clinical, and angiographic characteristics of patients admitted with STEMI. We also calculated cardiovascular event risk using the FRS in a subset of patients without prior known coronary artery disease and diabetes mellitus.
A total of 44 patients, predominantly men (75%) and white (80%), with a mean age of 56 ± 10 years, were included in our analysis. Cigarette smoking was the predominant risk factor (83%) followed by hypertension (77%) and dyslipidemia (68%). The calculated FRS in a subset of patients without prior coronary artery disease or diabetes mellitus was 14.1% ± 5.8%. Based on the FRS, 8 (36%) patients had a 10-year risk >20% and 14 (63%) patients had a 10-year risk between 10% and 20%.
In a series of consecutive patients with STEMI, we observed that high FRS was inadequate in correct identification and risk stratification of the majority of patients who had STEMI. Our study underlines the importance of being familiar with multiple risk scores and choosing the most applicable risk score based on the patient's individual characteristics. In addition, it is important to take into consideration the nontraditional risk factors or measurement of coronary artery calcium as a part of the risk assessment algorithm.
本研究的目的是确定ST段抬高型心肌梗死(STEMI)患者的危险因素和临床特征。我们进一步评估了弗明汉风险评分(FRS)在这些患者冠状动脉事件发生前用于准确识别的效用。
我们评估了STEMI入院患者的人口统计学、临床和血管造影特征。我们还在一部分无已知冠状动脉疾病和糖尿病的患者中使用FRS计算心血管事件风险。
我们的分析纳入了共44例患者,主要为男性(75%)和白人(80%),平均年龄56±10岁。吸烟是主要危险因素(83%),其次是高血压(77%)和血脂异常(68%)。在一部分无先前冠状动脉疾病或糖尿病的患者中计算出的FRS为14.1%±5.8%。根据FRS,8例(36%)患者10年风险>20%,14例(63%)患者10年风险在10%至20%之间。
在一系列连续的STEMI患者中,我们观察到高FRS在正确识别和对大多数STEMI患者进行风险分层方面并不充分。我们的研究强调了熟悉多种风险评分并根据患者个体特征选择最适用风险评分的重要性。此外,将非传统危险因素或冠状动脉钙化测量作为风险评估算法的一部分加以考虑也很重要。