预测急性心肌梗死后出院和首次门诊就诊之间的心率变化对 SYNTAX 评分 II 的改善。

Prediction of SYNTAX score II improvement by adding temporal heart rate changes between discharge and first outpatient visit in patients with acute myocardial infarction.

机构信息

Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China.

出版信息

BMC Cardiovasc Disord. 2022 Nov 8;22(1):470. doi: 10.1186/s12872-022-02929-7.

DOI:10.1186/s12872-022-02929-7

PMID:36344932

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9641850/

Abstract

BACKGROUND

The prognostic ability of the temporal changes in resting heart rate (ΔHR) in patients with acute myocardial infarction (AMI) for cardiovascular (CV) mortality and clinical outcomes is rarely examined. This study investigated the predictive value of ΔHR using models with SYNTAX score II (SxS-II) for the long-term prognosis of patients with AMI.

METHODS

Six hundred five AMI patients with vital signs recorded at the first outpatient visit (2-4 weeks after discharge) were retrospectively recruited into this study. The changes between discharge and outpatient resting heart rate (D-O ΔHR) were calculated by subtracting the HR at the first post-discharge visit from the value recorded at discharge. The major adverse cardiovascular and cerebrovascular events (MACCE) include cardiovascular death, recurrent myocardial infarction, revascularization, and nonfatal stroke. The predictive values and reclassification ability of the different models were assessed using a likelihood ratio test, Akaike's information criteria (AIC), receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

RESULTS

During the follow-up period, a drop-in resting heart rate (RHR) from discharge to first outpatient visit was independently associated with less risk of CV mortality [D-O ΔHR: hazards ratio (HR) = 0.97, 95% CI = 0.96-0.99, P < 0.001] and MACCE (HR = 0.98, 95% CI = 0.97-0.99, p = 0.001). The likelihood test indicated that the combined model of SxS-II and D-O ΔHR yielded the lowest AIC for CV mortality and MACCE (P < 0.001). Moreover, D-O ΔHR alone significantly improved the net reclassification and integrated discrimination of the models containing SxS-II for CV mortality and MACCE (CV mortality: NRI = 0.5600, P = 0.001 and IDI = 0.0759, P = 0.03; MACCE: NRI = 0.2231, P < 0.05 and IDI = 0.0107, P < 0.05).

CONCLUSIONS

The change in D-O ΔHR was an independent predictor of long-term CV mortality and MACCE. The D-O ΔHR combined with SxS-II could significantly improve its predictive probability.

摘要

背景

静息心率（ΔHR）在急性心肌梗死（AMI）患者中的时间变化对心血管（CV）死亡率和临床结局的预测能力很少被研究。本研究使用 SYNTAX 评分 II（SxS-II）模型探讨了 ΔHR 的预测价值，以评估 AMI 患者的长期预后。

方法

本研究回顾性纳入了 605 例 AMI 患者，这些患者在首次门诊就诊时（出院后 2-4 周）记录了生命体征。通过从出院时记录的值中减去第一次出院后就诊时的 HR，计算出院与门诊静息心率（D-O ΔHR）之间的变化。主要不良心血管和脑血管事件（MACCE）包括心血管死亡、复发性心肌梗死、血运重建和非致命性卒中。使用似然比检验、赤池信息量准则（AIC）、接收者操作特征（ROC）曲线、净重新分类改善（NRI）和综合判别改善（IDI）评估不同模型的预测价值和再分类能力。

结果

在随访期间，从出院到首次门诊就诊时静息心率（RHR）下降与 CV 死亡率（D-O ΔHR：风险比[HR] = 0.97，95%CI = 0.96-0.99，P < 0.001）和 MACCE（HR = 0.98，95%CI = 0.97-0.99，p = 0.001）风险降低独立相关。似然比检验表明，SxS-II 与 D-O ΔHR 的联合模型在 CV 死亡率和 MACCE 方面具有最低的 AIC（P < 0.001）。此外，D-O ΔHR 单独可显著改善包含 SxS-II 的模型在 CV 死亡率和 MACCE 方面的净重新分类和综合判别（CV 死亡率：NRI = 0.5600，P = 0.001 和 IDI = 0.0759，P = 0.03；MACCE：NRI = 0.2231，P < 0.05 和 IDI = 0.0107，P < 0.05）。