Department of Military Therapy of the Ukrainian Military Medical Academy, 01015 Kyiv, Ukraine.
Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 02-091 Warsaw, Poland.
Medicina (Kaunas). 2021 Dec 10;57(12):1349. doi: 10.3390/medicina57121349.
The management of ST-segment elevation myocardial infarction (STEMI) requires a patient's long-term risk to be estimated. The objective of this study was to develop extended and simplified models of two-year death risk estimation following STEMI that include and exclude cardiac troponins as prognostic factors and to compare their performance with each other. : Extended and simplified multivariable logistic regression models were elaborated using 1103 patients with STEMI enrolled and followed up in the STIMUL (ST-segment elevation Myocardial Infarctions in Ukraine and their Lethality) registry. Results: The extended STIMUL risk score includes seven independent risk factors: age; Killip class ≥ II at admission; resuscitated cardiac arrest; non-reperfused infarct-related artery; troponin I ≥ 150.0 ng/L; diabetes mellitus; and history of congestive heart failure. The exclusion of cardiac troponin in the simplified model did not influence the predictive value of each factor. Both models divide patients into low, moderate, and high risk groups with a C-statistic of 0.89 (95% CI 0.84-0.93; < 0.001) for the extended STIMUL model and a C-statistic of 0.86 (95% CI 0.83-0.99; < 0.001) for the simplified model. However, the addition of the level of troponin I to the model increased its prognostic value by 10.7%. : The STIMUL extended and simplified risk estimation models perform well in the prediction of two-year death risk following STEMI. The simplified version may be useful when clinicians do not know the value of cardiac troponins among the population of STEMI patients.
ST 段抬高型心肌梗死（STEMI）的管理需要估计患者的长期风险。本研究的目的是开发包含和排除心脏肌钙蛋白作为预后因素的两种用于估计 STEMI 后两年死亡风险的扩展和简化模型，并比较它们的性能。方法：使用纳入和随访于 STIMUL（乌克兰 ST 段抬高型心肌梗死及其致死率）注册研究的 1103 例 STEMI 患者，制定了扩展和简化的多变量逻辑回归模型。结果：扩展的 STIMUL 风险评分包含 7 个独立的危险因素：年龄；入院时 Killip 分级≥II 级；复苏性心脏骤停；未再灌注梗死相关动脉；肌钙蛋白 I≥150.0ng/L；糖尿病；充血性心力衰竭病史。简化模型中排除心脏肌钙蛋白并不影响各因素的预测价值。两种模型均将患者分为低危、中危和高危组，扩展 STIMUL 模型的 C 统计量为 0.89（95%CI 0.84-0.93；<0.001），简化模型的 C 统计量为 0.86（95%CI 0.83-0.99；<0.001）。然而，肌钙蛋白 I 水平的加入增加了模型 10.7%的预后价值。结论：STIMUL 扩展和简化风险评估模型在预测 STEMI 后两年死亡风险方面表现良好。当临床医生不知道 STEMI 患者人群中心脏肌钙蛋白的值时，简化版本可能会很有用。
