Parikh Trishna B, Aziz Moez, Mackoff Samuel P, Aisenberg Gabriel M
Internal Medicine, University of Texas, John P and Kathrine G McGovern School of Medicine, Houston, USA.
Cureus. 2023 Jun 14;15(6):e40408. doi: 10.7759/cureus.40408. eCollection 2023 Jun.
Objectives History, EKG, age, risk factors, and troponin (HEART) and thrombolysis in myocardial infarction (TIMI) risk calculators have been validated to predict the risk of subsequent acute coronary syndromes and in some studies, severe coronary atherosclerosis in patients with a concerning clinical history. Their performance in patients with end-stage renal disease (ESRD), a population with a high pretest probability for the condition, is unknown. We aimed to determine whether HEART and TIMI scores can predict severe coronary atherosclerosis in patients with end-stage renal disease (ESRD). Methods A single-center retrospective cohort of admitted patients aged 18 years or older with ESRD on dialysis who underwent coronary angiography during admission (November 2010 to December 2017) was retrospectively reviewed. The outcome of coronary angiography was compared with the calculated HEART and TIMI scores at the time of presentation. Receiver operating characteristics and logistic regression models were used to determine optimal score cutoffs, score usefulness, and associations between outcomes, scores, and patient characteristics. Results Among 231 patient encounters, the mean HEART and TIMI scores were 6±2 and 3±1 points, respectively. Patients with diabetes mellitus, those 65 years old and older, and those reported to have angina pectoris were more likely to show severe coronary artery disease (CAD) lesions. Optimal score cutoffs for determining severe coronary lesions were between six and seven (area under the curve (AUC)=0.754, confidence interval (CI): 0.682-0.826) and between three and four (AUC=0.716, CI: 0.640-0.792) for the HEART and TIMI scores, respectively. Conclusion Similar to the general population, HEART and TIMI scores can predict severe coronary atherosclerosis in the complex ESRD population.
目的 病史、心电图、年龄、危险因素及肌钙蛋白（HEART）风险计算器和心肌梗死溶栓（TIMI）风险计算器已被证实可预测后续急性冠脉综合征的风险，并且在一些研究中，可用于预测有相关临床病史患者的严重冠状动脉粥样硬化情况。它们在终末期肾病（ESRD）患者中的表现尚不清楚，而这一人群疾病的预检概率较高。我们旨在确定HEART和TIMI评分能否预测终末期肾病（ESRD）患者的严重冠状动脉粥样硬化情况。方法 对2010年11月至2017年12月期间收治的18岁及以上接受透析的ESRD住院患者进行单中心回顾性队列研究，这些患者在住院期间接受了冠状动脉造影。将冠状动脉造影结果与就诊时计算出的HEART和TIMI评分进行比较。采用受试者工作特征曲线和逻辑回归模型来确定最佳评分临界值、评分的有用性以及结果、评分和患者特征之间的关联。结果 在231例患者中，HEART和TIMI评分的平均值分别为6±2分和3±1分。患有糖尿病、年龄在65岁及以上以及报告有心绞痛的患者更有可能出现严重冠状动脉疾病（CAD）病变。确定严重冠状动脉病变的最佳评分临界值，HEART评分在6至7分之间（曲线下面积（AUC）=0.754，置信区间（CI）：0.682 - 0.826），TIMI评分在3至4分之间（AUC = 0.716，CI：0.640 - 0.792）。结论 与普通人群类似，HEART和TIMI评分可预测复杂的ESRD人群中的严重冠状动脉粥样硬化情况。
