J Healthc Qual. 2021;43(5):292-303. doi: 10.1097/JHQ.0000000000000296.
Improving patient outcomes after acute myocardial infarction (AMI) may be facilitated by identifying patients at a high risk of adverse events before hospital discharge. We aimed to determine the accuracy of the LACE (Length of stay, Acuity, Comorbidities, Emergency presentations within prior 6 months) index score (a prediction tool) for predicting 30-day all-cause mortality and readmission rates (independently and combined) in South Australian AMI patients who had an angiogram.
All consecutive AMI patients enrolled in the Coronary Angiogram Database of South Australia Registry at two major tertiary hospitals and discharged alive between July 2016 to June 2017. A LACE score was calculated for each patient, and receiver operating characteristic curve analysis was performed.
Analysis of registry patients found a 30-day unplanned readmission rate of 11.8% and mortality rate of 0.7%. Moreover, the LACE index was a moderate predictor (C-statistic = 0.62) of readmissions in this cohort, and a score ≥10 indicated moderate discriminatory capacity to predict 30-day readmissions.
The LACE index shows moderate discriminatory capacity to predict 30-day readmissions and mortality. A cut-off score of nine to optimize sensitivity may assist clinicians in identifying patients at a high risk of adverse outcomes.
通过在出院前识别出发生不良事件风险较高的患者，可能有助于改善急性心肌梗死（AMI）患者的预后。我们旨在确定 LACE（住院时间、 acuity、合并症、前 6 个月内急诊就诊）指数评分（预测工具）在预测接受血管造影的南澳大利亚 AMI 患者 30 天全因死亡率和再入院率（独立和联合）方面的准确性。
本研究纳入了 2016 年 7 月至 2017 年 6 月在两家主要三级医院接受血管造影的连续 AMI 患者。为每位患者计算 LACE 评分，并进行接收者操作特征曲线分析。
对登记患者的分析发现，30 天非计划性再入院率为 11.8%，死亡率为 0.7%。此外，LACE 指数是该队列中再入院的中度预测指标（C 统计量=0.62），评分≥10 表明对 30 天再入院具有中等的区分能力。
LACE 指数对预测 30 天再入院和死亡率具有中等的区分能力。9 分的截断值可优化灵敏度，有助于临床医生识别发生不良结局风险较高的患者。
