非 ST 段抬高型心肌梗死患者的临床转归和对重症监护的需求。

Clinical outcomes and need for intensive care after non-ST-segment-elevation myocardial infarction.

机构信息

Samaritano Paulista Hospital, Sao Paulo, Brazil.

出版信息

Eur J Intern Med. 2020 Jun;76:58-63. doi: 10.1016/j.ejim.2020.02.008. Epub 2020 Feb 20.

DOI:10.1016/j.ejim.2020.02.008

PMID:32089424

Abstract

BACKGROUND

The decision on whether non-ST-segment elevation myocardial infarction (NSTEMI) patients should be admitted to intensive care units (ICU) takes into account several factors including hospital routines. The Acute Coronary Treatment and Intervention Outcomes Network (ACTION) ICU score was developed to predict complications requiring ICU care post-NSTEMI.

METHODS

We described patient characteristics and clinical outcomes of 1263 NSTEMI patients admitted to a private hospital in Sao Paulo, Brazil, from 2014 to 2018. We also aimed to retrospectively identify NSTEMI patients who might not have needed to be admitted to the ICU based on the ACTION ICU risk score. We defined complications requiring ICU care post-NSTEMI as cardiac arrest, cardiogenic shock, stroke, re-infarction, death, heart block requiring pacemaker placement, respiratory failure, or sepsis.

RESULTS

Mean age was 62.3 years and 35.8% were female. A total of 94.6% of NSTEMI patients were admitted to the ICU. Most NSTEMI patients (91.9%) underwent coronary angiography. Percutaneous coronary intervention was performed in 47.1% and coronary artery bypass graft surgery in 10.3%. Complications requiring ICU care occurred in 62 patients (4.9%). In-hospital mortality rate was 1.3%. Overall, 70.4% had an ACTION ICU score ≤ 5. The C-statistics for the ACTION risk score to predict complications was 0.55 (95% confidence interval 0.47-0.63).

CONCLUSIONS

Complications requiring ICU care were infrequent in a cohort of NSTEMI patients who were routinely admitted to the ICU over a 4-year period. The ACTION risk score had low accuracy in the prediction of complications requiring ICU care in our population.

摘要

背景

非 ST 段抬高型心肌梗死（NSTEMI）患者是否应入住重症监护病房（ICU）的决策考虑了包括医院常规在内的多种因素。急性冠状动脉治疗和干预结果网络（ACTION）ICU 评分旨在预测 NSTEMI 后需要 ICU 护理的并发症。

方法

我们描述了 2014 年至 2018 年期间，巴西圣保罗一家私立医院收治的 1263 例 NSTEMI 患者的患者特征和临床结局。我们还旨在根据 ACTION ICU 风险评分回顾性确定可能不需要入住 ICU 的 NSTEMI 患者。我们将 NSTEMI 后需要 ICU 护理的并发症定义为心脏骤停、心源性休克、中风、再梗死、死亡、需要起搏器植入的心脏传导阻滞、呼吸衰竭或败血症。

结果

平均年龄为 62.3 岁，35.8%为女性。94.6%的 NSTEMI 患者被收入 ICU。大多数 NSTEMI 患者（91.9%）接受了冠状动脉造影。47.1%的患者接受了经皮冠状动脉介入治疗，10.3%的患者接受了冠状动脉旁路移植术。62 例（4.9%）患者发生需要 ICU 护理的并发症。住院死亡率为 1.3%。总体而言，70.4%的患者 ACTION ICU 评分≤5。ACTION 风险评分预测并发症的 C 统计量为 0.55（95%置信区间 0.47-0.63）。