Kawai Tsutomu, Nakatani Daisaku, Yamada Takahisa, Sakata Yasuhiko, Hikoso Shungo, Mizuno Hiroya, Suna Shinichiro, Kitamura Tetsuhisa, Okada Katsuki, Dohi Tomoharu, Kojima Takayuki, Oeun Bolrathanak, Sunaga Akihiro, Kida Hirota, Sato Hiroshi, Hori Masatsugu, Komuro Issei, Tamaki Shunsuke, Morita Takashi, Fukunami Masatake, Sakata Yasushi
Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Int J Cardiol Heart Vasc. 2021 Mar 11;33:100748. doi: 10.1016/j.ijcha.2021.100748. eCollection 2021 Apr.
Estimated plasma volume status (ePVS) is a well-validated prognostic indicator in heart failure. However, it remains unclear whether ePVS has prognostic significance in patients with acute myocardial infarction (AMI). Moreover, there is no available information on its additive effect with the Global Registry of Acute Coronary Events (GRACE) risk score in AMI patients.
Data were obtained from the Osaka Acute Coronary Insufficiency Study (OACIS) registry database. Patients whose data were available for ePVS derived from Hakim's formula and the GRACE risk score were studied. The primary endpoints were in-hospital and 5-year mortality.
Of 3930 patients, 206 and 200 patients died during hospitalization and 5 years after discharge, respectively. After adjustment, ePVS remained an independent predictor of in-hospital death (OR:1.02, 95% CI: 1.00-1.04, p = 0.036), and 5-year mortality(HR:1.03, 95% CI: 1.01-1.04, p < 0.001). An additive effect of ePVS with the GRACE risk score was observed in predicting the 5-year mortality with an area under the receiver operating characteristic curve (AUC) from 0.744 to 0.763 (p = 0.026), but not in-hospital mortality (the AUC changed from 0.875 to 0.875, p = 0.529). The incremental predictive value of combining ePVS and the GRACE risk score for 5-year mortality was significantly improved, as shown by the net reclassification improvement (NRI:0.378, p < 0.001) and integrated discrimination improvement (IDI:0.014, p < 0.001).
In patients with AMI, ePVS independently predicted in-hospital and long-term mortality. In addition, ePVS had an additive effect with the GRACE risk score on long-term mortality. Therefore, ePVS may be useful for identifying high-risk subjects for intensive treatment.
估计血浆容量状态（ePVS）是心力衰竭中经过充分验证的预后指标。然而，ePVS在急性心肌梗死（AMI）患者中是否具有预后意义仍不清楚。此外，关于其在AMI患者中与全球急性冠状动脉事件注册研究（GRACE）风险评分的相加作用尚无可用信息。
数据来自大阪急性冠状动脉功能不全研究（OACIS）注册数据库。研究了可获得根据哈基姆公式得出的ePVS数据和GRACE风险评分的患者。主要终点是住院期间和5年死亡率。
在3930例患者中，分别有206例和200例患者在住院期间和出院后5年死亡。调整后，ePVS仍然是住院死亡（OR：1.02，95%CI：1.00 - 1.04，p = 0.036）和5年死亡率（HR：1.03，95%CI：1.01 - 1.04，p < 0.001）的独立预测因素。在预测5年死亡率方面观察到ePVS与GRACE风险评分有相加作用，受试者工作特征曲线下面积（AUC）从0.744变为0.763（p = 0.026），但在住院死亡率方面未观察到（AUC从0.875变为0.875，p = 0.529）。联合ePVS和GRACE风险评分对5年死亡率的增量预测价值显著提高，净重新分类改善（NRI：0.378，p < 0.001）和综合判别改善（IDI：0.014，p < 0.001）表明了这一点。
在AMI患者中，ePVS独立预测住院和长期死亡率。此外，ePVS在长期死亡率方面与GRACE风险评分有相加作用。因此，ePVS可能有助于识别强化治疗的高危患者。
