Yao Jianhua, Xie Yuan, Liu Yang, Tang Yu, Xu Jiahong
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Front Cardiovasc Med. 2020 Aug 13;7:130. doi: 10.3389/fcvm.2020.00130. eCollection 2020.
Acute myocardial infarction (AMI) is among the leading causes of death worldwide. Patients with AMI may have the risk of developing recurrent cardiovascular events leading to rehospitalization or even death. The present study aimed to investigate the prediction factors of poor prognosis (mortality and/or readmission) after AMI during a 6-month follow-up. A total of 206 consecutive patients hospitalized for the first visit with AMI were enrolled. Data collection included demographic characteristics, medical history, clinical information, laboratory results, and oral medications within 24 h of admission. At 1, 3, and 6 months after discharge, AMI patients were followed up to assess the occurrence of composite endpoint events including in-hospital and out-of-hospital death and/or readmission due to recurrent myocardial infarction (MI) or exacerbated symptoms of heart failure following MI. After 6-month follow-up, a total of 197 AMI patients were available and divided in two groups according to good prognosis ( = 144) and poor prognosis ( = 53). Our data identified serum myoglobin ≥651 ng/mL, serum creatinine ≥96 μM, Killip classification 2-4, and female gender as independent predictors of 6-month mortality and/or readmission after AMI. Moreover, we demonstrated that Killip classification 2-4 combined with either myoglobin (AUC = 0.784, sensitivity = 69.8%, specificity = 79.9%) or creatinine (AUC = 0.805, sensitivity = 75.5%, specificity = 77.1%) could further enhance the predictive capacity of poor 6-month prognosis among AMI patients. Patients with AMI ranked in the higher Killip class need to be evaluated and monitored with attention. Multibiomarker approach using Killip classification 2-4 and myoglobin or creatinine may be an effective way for 6-month prognosis prediction in AMI patients.
急性心肌梗死（AMI）是全球主要死因之一。AMI患者可能有发生心血管事件复发的风险，导致再次住院甚至死亡。本研究旨在调查AMI患者6个月随访期间预后不良（死亡率和/或再入院率）的预测因素。共纳入206例首次因AMI住院的连续患者。数据收集包括人口统计学特征、病史、临床信息、实验室检查结果以及入院后24小时内的口服药物。出院后1个月、3个月和6个月，对AMI患者进行随访，以评估复合终点事件的发生情况，包括住院和院外死亡以及因复发性心肌梗死（MI）或MI后心力衰竭症状加重导致的再入院。6个月随访后，共有197例AMI患者可供分析，并根据预后良好（n = 144）和预后不良（n = 53）分为两组。我们的数据确定血清肌红蛋白≥651 ng/mL、血清肌酐≥96 μM、Killip分级2 - 4级以及女性为AMI后6个月死亡率和/或再入院的独立预测因素。此外，我们还证明，Killip分级2 - 4级联合肌红蛋白（AUC = 0.784，敏感性 = 69.8%，特异性 = 79.9%）或肌酐（AUC = 0.805，敏感性 = 75.5%，特异性 = 77.1%）可进一步提高AMI患者6个月预后不良的预测能力。Killip分级较高的AMI患者需要予以密切评估和监测。使用Killip分级2 - 4级和肌红蛋白或肌酐的多生物标志物方法可能是预测AMI患者6个月预后的有效方法。
