稳定型冠心病患者常规资料的预后价值。对疾病过程中随机时间点抽样的患者进行 10 年随访。
Prognostic value of routinely available data in patients with stable coronary heart disease. A 10-year follow-up of patients sampled at random times during their disease course.
机构信息
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital Blegdamsvej, Copenhagen, Denmark.
Department of Cardiology, Holbæk Hospital, Holbæk, Denmark.
出版信息
Open Heart. 2018 Sep 5;5(2):e000808. doi: 10.1136/openhrt-2018-000808. eCollection 2018.
OBJECTIVE
To characterise the long-term prognosis of patients with stable coronary artery heart disease by means of 'standard predictors' defined as demographic, clinical and biochemical quantities routinely available in general practices and ascertained at an interview not prompted by renewed cardiac complaints.
METHODS
This is an observational study based on data from 2199 Copenhagen placebo patients from the 'clarithromycin for patients with stable coronary heart disease' trial of patients with stable coronary heart disease. In the trial, we compared the effects of 14 days of clarithromycin treatment versus placebo. The predictors were based on the interview forms and blood samples collected at entry, along with demographic information from hospital files.We studied 'standard predictors' of a composite outcome (myocardial infarction, unstable angina, cerebrovascular disease or all-cause death) and of all-cause death. Using Cox regression, we compared predictions of status at 3, 6 and 9 years without and with the use of 'standard predictors' and used receiver operating characteristic statistic.
RESULTS
Few 'standard predictors' were associated (p<0.01) with the composite outcome or with all-cause death. When no 'standard predictors' were included, 63.2% of the model-based predictions of the composite outcome and 79.9% of death predictions were correct. Including all 'standard predictors' in the model increased the figures to 68.4% and 83.4%, respectively. indices were low, except when all-cause death was assessed as a single outcome where was 0.79.
CONCLUSION
'Standard predictors' routinely available in general practices contribute only modestly to risk assessment in consecutively sampled patients with stable coronary heart disease as ascertained at a contact not prompted by renewed cardiac complaints. Novel biomarkers may improve the assessment.
TRIAL REGISTRATION NUMBER
NCT00121550.
目的
通过“标准预测因子”来描述稳定型冠心病患者的长期预后，这些预测因子是指在一般实践中常规可用的人口统计学、临床和生化指标，并在非因心脏症状复发而引发的访谈中确定。
方法
这是一项观察性研究，基于来自“克拉霉素治疗稳定型冠心病患者”试验的 2199 名哥本哈根安慰剂患者的数据，该试验比较了 14 天克拉霉素治疗与安慰剂的效果。预测因子基于访谈表格和入组时采集的血液样本，以及来自医院档案的人口统计学信息。我们研究了复合结局（心肌梗死、不稳定型心绞痛、脑血管疾病或全因死亡）和全因死亡的“标准预测因子”。使用 Cox 回归，我们比较了在不使用和使用“标准预测因子”的情况下，3、6 和 9 年时的状态预测，并使用了接收者操作特征统计量。
结果
很少有“标准预测因子”与复合结局或全因死亡相关（p<0.01）。当不包括“标准预测因子”时，复合结局的模型预测中 63.2%和死亡预测中 79.9%的情况是正确的。将所有“标准预测因子”纳入模型后，这两个数字分别提高到 68.4%和 83.4%。除了将全因死亡作为单一结局评估时，C 指数较低（为 0.79）外，其他情况的 C 指数均较低。
结论
在一般实践中常规可用的“标准预测因子”仅对稳定型冠心病患者的风险评估有适度贡献，这些患者是在非因心脏症状复发而引发的访谈中确定的。新型生物标志物可能会改善评估。
临床试验注册号
NCT00121550。
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