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丹麦合并症指数评分对美国 250 万例急性心肌梗死患者治疗和结局的影响。

Influence of the Danish Co-morbidity Index Score on the Treatment and Outcomes of 2.5 Million Patients Admitted With Acute Myocardial Infarction in the United States.

机构信息

School of Medicine, Keele University, Keele, Staffordshire, United Kingdom.

Department of Cardiology, University Hospital of Split, Split, Croatia; Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Staffordshire, United Kingdom.

出版信息

Am J Cardiol. 2022 Sep 15;179:1-10. doi: 10.1016/j.amjcard.2022.06.008. Epub 2022 Jul 15.

Abstract

This study aimed to determine the association between the Danish Co-morbidity Index for Acute Myocardial Infarction (DANCAMI) and restricted DANCAMI (rDANCAMI) scores and clinical outcomes in patients hospitalized with AMI. Using the National Inpatient Sample, all AMI hospitalizations were stratified into four groups based on their DANCAMI and rDANCAMI score (0; 1 to 3; 4 to 5; ≥6). The primary outcome was all-cause mortality, whereas secondary outcomes were major adverse cardiovascular/cerebrovascular events, major bleeding, ischemic stroke, and receipt of coronary angiography or percutaneous coronary intervention. Multivariate logistic regression was used to determine adjusted odds ratios (aOR) with 95% confidence intervals (95% CIs). Patients with DANCAMI risk score ≥6 were more likely to suffer mortality (aOR 2.30, 95% CI 2.24 to 2.37) and bleeding (aOR 5.85, 95% CI 5.52 to 6.21) and were less likely to receive coronary angiography (aOR 0.34, 95% CI 0.33 to 0.34) and percutaneous coronary intervention (aOR 0.29, 95% CI 0.28 to 0.29) compared with patients with DANCAMI score of 0. Similar results were observed for the rDANCAMI score. In conclusion, increased DANCAMI and rDANCAMI scores were associated with worse in-hospital outcomes in patients with AMI and lower odds of invasive management. The use of co-morbidity scores identifies patients at high risk of adverse outcomes and highlights disparities in care.

摘要

本研究旨在确定丹麦急性心肌梗死合并症指数(DANCAMI)和限制 DANCAMI(rDANCAMI)评分与急性心肌梗死(AMI)住院患者临床结局之间的关联。利用国家住院患者样本,根据 DANCAMI 和 rDANCAMI 评分(0;1 至 3;4 至 5;≥6),将所有 AMI 住院患者分为四组。主要结局是全因死亡率,次要结局是主要不良心血管/脑血管事件、大出血、缺血性卒中和接受冠状动脉造影或经皮冠状动脉介入治疗。采用多变量逻辑回归确定调整后的优势比(aOR)及其 95%置信区间(95%CI)。DANCAMI 风险评分≥6 的患者更有可能发生死亡(aOR 2.30,95%CI 2.24 至 2.37)和出血(aOR 5.85,95%CI 5.52 至 6.21),更不可能接受冠状动脉造影(aOR 0.34,95%CI 0.33 至 0.34)和经皮冠状动脉介入治疗(aOR 0.29,95%CI 0.28 至 0.29),与 DANCAMI 评分为 0 的患者相比。rDANCAMI 评分也观察到类似的结果。总之,DANCAMI 和 rDANCAMI 评分升高与 AMI 患者住院期间预后较差和侵入性治疗可能性降低相关。合并症评分的使用可识别出高风险不良结局的患者,并突出了护理方面的差异。

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