Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China.
Department of Internal Medicine, Ling Shui Li Autonomous County People's Hospital, Hainan, China.
Eur J Intern Med. 2020 Jan;71:57-61. doi: 10.1016/j.ejim.2019.10.012. Epub 2019 Nov 12.
Although rare, infection in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) significantly increases mortality. Therefore, it is important to identify patients at high risk of infection. We aimed to validate the value of the Canada Acute Coronary Syndrome (C-ACS) risk score for predicting infection in such patients.
We conducted a prospective cohort study. Consecutive patients with STEMI undergoing PCI at our hospital from January 2010 to June 2016 were enrolled . C-ACS risk score was calculated based on the following clinical parameters (1 point for each): age ≥ 75 years, Killip class >1, systolic blood pressure <100 mmHg, and heart rate > 100 beats/min. The primary outcome was development of post-acute myocardial infarction (P-AMI) infection.
A total of 2198 patients were enrolled, of whom 424 (18.5%) developed infection. The incidence of infection, in-hospital mortality, and major adverse clinical events (MACE) were significantly higher in those with a C-ACS risk score ≥2. After adjusting for potential risk factors, C-ACS risk score remained a significant predictor of P-AMI infection (odds ratio [OR] = 2.27, 95% confidence interval [CI] = 1.92-2.67, p < 0.001), in-hospital mortality, and MACE. Receiver operating characteristic curves demonstrated the C-ACS risk score had good predictive value for P-AMI infection (area under the curve = 0.783, 95% CI = 0.759-0.806, P < 0.001), in-hospital mortality and MACE.
The C-ACS risk score was a good predictor of P-AMI infection, and other clinical outcomes.
尽管罕见，但接受经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者发生感染会显著增加死亡率。因此，识别感染风险较高的患者非常重要。我们旨在验证加拿大急性冠状动脉综合征（C-ACS）风险评分预测此类患者感染的价值。
我们进行了一项前瞻性队列研究。连续纳入 2010 年 1 月至 2016 年 6 月在我院接受 PCI 的 STEMI 患者。根据以下临床参数计算 C-ACS 风险评分（每项 1 分）：年龄≥75 岁、Killip 分级>1、收缩压<100mmHg 和心率>100 次/分。主要结局为急性心肌梗死后（P-AMI）感染。
共纳入 2198 例患者，其中 424 例（18.5%）发生感染。C-ACS 风险评分≥2 的患者感染发生率、住院死亡率和主要不良临床事件（MACE）更高。在调整潜在危险因素后，C-ACS 风险评分仍然是 P-AMI 感染的显著预测因素（比值比 [OR] 为 2.27，95%置信区间 [CI] 为 1.92-2.67，p<0.001）、住院死亡率和 MACE。受试者工作特征曲线表明 C-ACS 风险评分对 P-AMI 感染具有良好的预测价值（曲线下面积 [AUC]为 0.783，95%CI 为 0.759-0.806，p<0.001）、住院死亡率和 MACE。
C-ACS 风险评分是 P-AMI 感染和其他临床结局的良好预测指标。
