Department of Internal Diseases with the Course of Cardiology and Functional Diagnostics named after V.S. Moiseev, Institute of Medicine, RUDN University, Moscow, Russia.
Department of Internal Diseases with the Course of Cardiology and Functional Diagnostics named after V.S. Moiseev, Institute of Medicine, RUDN University, Moscow, Russia; Vinogradov City Clinical Hospital, Moscow, Russia.
Am J Emerg Med. 2021 Oct;48:224-230. doi: 10.1016/j.ajem.2021.04.060. Epub 2021 Apr 27.
Despite the poor prognosis in patients with type 2 myocardial infarction (MI), no prospective data on risk stratification exists. The aim of this study was to develop and validate a model for prediction of 18-month mortality of among patients with type 2 MI (T2MI) and compare its performance with GRACE and TARRACO scores.
The prospective observational study included 712 consecutive patients diagnosed with MI undergoing coronary angiography <24 h between January 2017 and December 2018. Diagnosis of T2MI was adjusted according to Third universal definition. A prognostic model was developed by using Bayesian approach and logistic regression analysis with identifying predictors for mortality. The model was validated by bootstrap validation. Comparison performance between scores using Delong test.
T2MI was identified in 174 (24.4%) patients. The median age of patients was 69 years, 52% were female. The mortality rate was 20.1% at 18 months. Prior MI, presence of ST elevation, hemoglobin level at admission, Charlson comorbidity index and were independently associated with 18-month mortality. The model to predict 18-month mortality showed excellent discrimination (optimism corrected c-statistic = 0.822) and calibration (corrected slope = 0.893). GRACE and TARRACO scores had moderate discrimination [c-statistic = 0.748 (95% CI 0.652-0.843) and 0.741, 95% CI 0.669-0.805), respectively] and inferior compared with model (p = 0.043 and 0.037, respectively).
The risk of mortality among T2MI patients could be accurately predicted by using common clinical characteristics and laboratory tests. Further studies are required with external validation of nomogram prior to clinical implementation.
尽管 2 型心肌梗死（MI）患者的预后较差，但目前尚无关于风险分层的前瞻性数据。本研究旨在为 2 型 MI（T2MI）患者建立并验证一个预测 18 个月死亡率的模型，并与 GRACE 和 TARRACO 评分进行比较。
本前瞻性观察性研究纳入了 2017 年 1 月至 2018 年 12 月期间在发病 24 小时内行冠状动脉造影检查的 712 例连续确诊为 MI 的患者。T2MI 的诊断根据第三次通用定义进行调整。采用贝叶斯方法和逻辑回归分析确定预测死亡的因素来建立预后模型。通过自举验证法对模型进行验证。采用 DeLong 检验比较各评分的性能。
共发现 174 例（24.4%）T2MI 患者。患者中位年龄为 69 岁，52%为女性。18 个月的死亡率为 20.1%。既往心肌梗死、ST 段抬高、入院时血红蛋白水平、Charlson 合并症指数与 18 个月死亡率独立相关。预测 18 个月死亡率的模型具有良好的判别能力（校正后的最优 C 统计量=0.822）和校准度（校正斜率=0.893）。GRACE 和 TARRACO 评分的判别能力为中度[C 统计量分别为 0.748（95%CI 0.652-0.843）和 0.741，95%CI 0.669-0.805]，且与模型相比劣于模型（分别为 p=0.043 和 0.037）。
可使用常见的临床特征和实验室检查结果准确预测 T2MI 患者的死亡风险。在临床应用前，需要进一步进行外部验证。
