Zhou Jian, Shan Pei-Ren, Xie Qiang-Li, Zhou Xiao-Dong, Cai Meng-Xing, Xu Tian-Cheng, Huang Wei-Jian
Coron Artery Dis. 2019 Sep;30(6):398-405. doi: 10.1097/MCA.0000000000000759.
Early identification of high-risk patients provides clinicians with greater decision-making time and better informs strategies to cope with disease. The predictive values of age shock index (age SI) and age-modified shock index (age MSI) in ST-segment elevation myocardial infarction (STEMI) patients undergoing emergency percutaneous coronary intervention (PCI) have rarely been reported, especially compared with those for SI, MSI, and the Global Registry of Acute Coronary Events (GRACE) risk score.
Nine hundred and eighty-three STEMI patients undergoing emergency PCI between January 2014 and September 2017 were analyzed in a retrospective cohort study. The primary outcomes were rates of in-hospital cardiovascular events, and 6-month and long-term all-cause mortality.
In multivariate analyses, the predictive values of age SI and age MSI were comparable to that of the GRACE score, but superior to those of SI and MSI for in-hospital cardiac mortality [age SI: odds ratio (OR) = 1.05, P < 0.001, area under the receiver operating characteristic (ROC-AUC) = 0.805, P < 0.001; age MSI: OR = 1.04, P < 0.001, ROC-AUC = 0.813, P < 0.001; GRACE score: OR = 1.03, P < 0.001, ROC-AUC = 0.827, P < 0.001], 6-month all-cause mortality (age SI: OR = 1.04, P < 0.001, ROC-AUC = 0.791, P < 0.001; age MSI: OR = 1.03, P < 0.001, ROC-AUC = 0.801, P < 0.001; GRACE score: ROC-AUC = 0.828, P < 0.001), long-term all-cause mortality [age SI: hazard ratio (HR) = 1.06, P < 0.001, ROC-AUC = 0.798, P < 0.001; age MSI: HR = 1.04, P < 0.001, ROC-AUC = 0.84, P < 0.001; GRACE score: ROC-AUC = 0.822, P < 0.001] and post-discharge all-cause mortality (age SI: HR = 1.05, P < 0.001, ROC-AUC = 0.78, P = 0.001; age MSI: HR = 1.05, P < 0.001, ROC-AUC = 0.789, P < 0.001; GRACE score: ROC-AUC = 0.812, P < 0.001).
Age SI and age MSI are stronger predictors than SI and MSI for in-hospital cardiovascular events, and 6-month and long-term all-cause mortality in STEMI patients undergoing emergency PCI. Age SI and age MSI appear to be convenient and simpler indicators than the GRACE score.
早期识别高危患者可为临床医生提供更多决策时间，并更好地指导应对疾病的策略。年龄休克指数（age SI）和年龄修正休克指数（age MSI）在接受急诊经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者中的预测价值鲜有报道，尤其是与休克指数（SI）、修正休克指数（MSI）及全球急性冠状动脉事件注册研究（GRACE）风险评分相比。
在一项回顾性队列研究中，分析了2014年1月至2017年9月期间983例接受急诊PCI的STEMI患者。主要结局为院内心血管事件发生率、6个月及长期全因死亡率。
在多变量分析中，年龄SI和年龄MSI的预测价值与GRACE评分相当，但在预测院内心脏死亡率方面优于SI和MSI [年龄SI：比值比（OR）=1.05，P<0.001，受试者工作特征曲线下面积（ROC-AUC）=0.805，P<0.001；年龄MSI：OR = 1.04，P<0.001，ROC-AUC = 0.813，P<0.001；GRACE评分：OR = 1.03，P<0.001，ROC-AUC = 0.827，P<0.001]、6个月全因死亡率（年龄SI：OR = 1.04，P<0.001，ROC-AUC = 0.791，P<0.001；年龄MSI：OR = 1.03，P<0.001，ROC-AUC = 0.801，P<0.001；GRACE评分：ROC-AUC = 0.828，P<0.001）、长期全因死亡率[年龄SI：风险比（HR）= 1.06，P<0.001，ROC-AUC = 0.798，P<0.001；年龄MSI：HR = 1.04，P<0.001，ROC-AUC = 0.84，P<0.001；GRACE评分：ROC-AUC = 0.822，P<0.001]及出院后全因死亡率（年龄SI：HR = 1.05，P<0.001，ROC-AUC = 0.78，P = 0.001；年龄MSI：HR = 1.05，P<0.001，ROC-AUC = 0.789，P<0.001；GRACE评分：ROC-AUC = 0.812，P<0.001）。
对于接受急诊PCI的STEMI患者，年龄SI和年龄MSI在预测院内心血管事件、6个月及长期全因死亡率方面比SI和MSI更强。年龄SI和年龄MSI似乎是比GRACE评分更简便的指标。
