Liu Yuanhui, Wang Litao, Chen Pengyuan, Dai Yining, Lin Yaowang, Chen Wei, Xu Zhengrong, Zeng Lihuan, Fan Hualin, Xue Ling, Liu Simin, Chen Jiyan, Tan Ning, He Pengcheng, Duan Chongyang
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Cardiovasc Med. 2022 Apr 15;9:845307. doi: 10.3389/fcvm.2022.845307. eCollection 2022.
Infection during hospitalization is a serious complication among patients who suffered from acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI); however, there are no suitable and accurate means to assess risk. This study aimed to develop and validate a simple scoring system to predict post-AMI infection in such patients.
All patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI consecutively enrolled from January 2010 to May 2016 were served as derivation cohort, and those from June 2016 to May 2018 as validation cohort, respectively. The primary endpoint was post-AMI infection during hospitalization, and all-cause death and major adverse cardiovascular events (MACE) were considered as secondary endpoints. The simplified risk model was established using logistic regression. The area under the receiver operating curve and calibration of predicted and observed infection risk were calculated.
A 24-point risk score was developed, with infection risk ranging from 0.7 to 99.6% for patients with the lowest and highest score. Seven variables including age, Killip classification, insulin use, white blood cell count, serum albumin, diuretic use, and transfemoral approach were included. This model achieved the same high discrimination in the development and validation cohort (C-statistic:0.851) and revealed adequate calibration in both datasets. The incidences of post-AMI infection increased steadily across risk score groups in both development (1.3, 5.1, 26.3, and 69.1%; < 0.001) and validation (1.8, 5.9, 27.2, and 79.2%; < 0.001) cohort. Moreover, the risk score demonstrated good performance for infection, in-hospital all-cause death, and MACE among these patients, as well as in patients with the non-ST-elevation acute coronary syndrome.
This present risk score established a simple bedside tool to estimate the risk of developing infection and other in-hospital outcomes in patients with STEMI undergoing PCI. Clinicians can use this risk score to evaluate the infection risk and subsequently make evidence-based decisions.
住院期间感染是接受经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者的严重并发症；然而，目前尚无合适且准确的风险评估方法。本研究旨在开发并验证一种简单的评分系统，以预测此类患者AMI后的感染情况。
将2010年1月至2016年5月连续纳入的所有接受PCI的ST段抬高型心肌梗死（STEMI）患者作为推导队列，将2016年6月至2018年5月的患者作为验证队列。主要终点为住院期间AMI后感染，全因死亡和主要不良心血管事件（MACE）被视为次要终点。使用逻辑回归建立简化风险模型。计算受试者工作特征曲线下面积以及预测和观察到的感染风险的校准情况。
开发了一个24分的风险评分，得分最低和最高的患者感染风险范围为0.7%至99.6%。纳入了七个变量，包括年龄、Killip分级、胰岛素使用情况、白细胞计数、血清白蛋白、利尿剂使用情况和经股动脉入路。该模型在推导队列和验证队列中具有相同的高辨别力（C统计量：0.851），并且在两个数据集中均显示出充分的校准。在推导队列（1.3%、5.1%、26.3%和69.1%；P<0.001）和验证队列（1.8%、5.9%、27.2%和79.2%；P<0.001）中，AMI后感染的发生率在各个风险评分组中均稳步上升。此外，风险评分在这些患者以及非ST段抬高急性冠状动脉综合征患者中，对于感染、院内全因死亡和MACE均表现出良好的性能。
本风险评分建立了一种简单的床边工具，用于估计接受PCI的STEMI患者发生感染和其他院内结局的风险。临床医生可使用该风险评分评估感染风险，进而做出基于证据的决策。
