Gheorghiade M, Anderson J, Rosman H, Lakier J, Velardo B, Goldberg D, Friedman A, Schultz L, Tilley B, Goldstein S
Henry Ford Heart and Vascular Institute, Detroit, MI.
Am Heart J. 1988 Nov;116(5 Pt 1):1212-7. doi: 10.1016/0002-8703(88)90442-5.
The in-hospital clinical course was evaluated in 2,162 consecutive patients admitted with a diagnosis of suspected myocardial infarction. Of these, 1609 patients were considered to be in the high-risk group, based on the presence of 16 clinical criteria present at the time of admission. The remaining 553 patients were classified as low risk. The overall rate of complications in the coronary care unit was greater in the high-risk group, 64%, compared to 26% in the low-risk group (p less than 0.001). Similarly life-threatening events (occurrence or recurrence of ventricular fibrillation, sustained ventricular tachycardia, complete heart block, asystole, or cardiogenic shock) were more common in the high risk-group compared to the low-risk group, 11% and 0.9%, respectively (p less than 0.001). The high-risk group required significantly more interventions, such as electrical cardioversion, temporary pacing, pulmonary artery catheterization, and intraaortic balloon counterpulsation, compared to the low-risk group (20% vs 2%, respectively; p less than 0.001). Myocardial infarction was confirmed in 892 patients in the high-risk group (55%) compared to 90 (16%) in the low-risk group (p less than 0.001). The coronary care unit mortality rate was greater in the high-risk group compared to the low-risk group (8.2% vs 0.4%, respectively; p less than 0.0002). It is concluded that based on readily available clinical criteria at the time of admission, a subgroup of patients at low risk for developing life-threatening complications requiring coronary care unit interventions can be identified and admitted directly to an intermediate-care unit.
对2162例连续入院且诊断为疑似心肌梗死的患者的院内临床病程进行了评估。其中，1609例患者因入院时存在16项临床标准而被视为高危组。其余553例患者被归类为低危组。高危组在冠心病监护病房的总体并发症发生率为64%，高于低危组的26%（p<0.001）。同样，危及生命的事件（室颤、持续性室性心动过速、完全性心脏传导阻滞、心搏停止或心源性休克的发生或复发）在高危组比低危组更常见，分别为11%和0.9%（p<0.001）。与低危组相比，高危组需要更多的干预措施，如电复律、临时起搏、肺动脉导管插入术和主动脉内球囊反搏（分别为20%和2%；p<0.001）。高危组892例患者（55%）确诊为心肌梗死，而低危组为90例（16%）（p<0.001）。高危组在冠心病监护病房的死亡率高于低危组（分别为8.2%和0.4%；p<0.0002）。结论是，根据入院时易于获得的临床标准，可以识别出一组发生危及生命并发症且需要冠心病监护病房干预的低风险患者亚组，并直接收入中级护理病房。
