急性心肌梗死后围术期预后不良患者的最佳 QTc 选择。

The optimal QTc selection in patients of acute myocardial infarction with poor perioperative prognosis.

机构信息

Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital, Anhui Medical University, Hefei, 230011, Anhui, China.

The Fifth Clinical School of Medicine, Anhui Medical University, Hefei, 230032, Anhui, China.

出版信息

BMC Cardiovasc Disord. 2023 Nov 10;23(1):551. doi: 10.1186/s12872-023-03594-0.

DOI:10.1186/s12872-023-03594-0

PMID:37950189

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10638740/

Abstract

BACKGROUND

The predictive utility of QTc values, calculated through various correction formulas for the incidence of postoperative major adverse cardiovascular and cerebrovascular events (MACCE) in patients experiencing acute myocardial infarction (AMI), warrants further exploration. This study endeavors to ascertain the predictive accuracy of disparate QTc values for MACCE occurrences in patients with perioperative AMI.

METHODS

A retrospective cohort of three hundred fourteen AMI patients, comprising 81 instances of in-hospital MACCE and 233 controls, was assembled, with comprehensive collection of baseline demographic and clinical data. QTc values were derived employing the correction formulas of Bazett, Fridericia, Hodges, Ashman, Framingham, Schlamowitz, Dmitrienko, Rautaharju, and Sarma. Analytical methods encompassed comparative statistics, Spearman correlation analysis, binary logistic regression models, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).

RESULTS

QTc values were significantly elevated in the MACCE cohort compared to controls (P < 0.05). Spearman's correlation analysis between heart rate and QTc revealed a modest positive correlation for the Sarma formula (QTcBaz) (ρ = 0.46, P < 0.001). Within the multifactorial binary logistic regression, each QTc variant emerged as an independent risk factor for MACCE, with the Sarma formula-derived QTc (QTcSar) presenting the highest hazard ratio (OR = 1.025). ROC curve analysis identified QTcSar with a threshold of 446 ms as yielding the superior predictive capacity (AUC = 0.734), demonstrating a sensitivity of 60.5% and a specificity of 82.8%. DCA indicated positive net benefits for QTcSar at high-risk thresholds ranging from 0 to 0.66 and 0.71-0.96, with QTcBaz, prevalent in clinical settings, showing positive net benefits at thresholds extending to 0-0.99.

CONCLUSION

For perioperative AMI patients, QTcSar proves more advantageous in monitoring QTc intervals compared to alternative QT correction formulas, offering enhanced predictive prowess for subsequent MACCE incidents.

摘要

背景

对于接受急性心肌梗死（AMI）治疗的患者，各种 QTc 校正公式计算的 QTc 值对术后主要不良心血管和脑血管事件（MACCE）的预测作用尚需进一步研究。本研究旨在确定不同 QTc 值对围手术期 AMI 患者 MACCE 发生的预测准确性。

方法

收集了 314 例 AMI 患者的回顾性队列研究数据，其中 81 例发生院内 MACCE，233 例为对照组，全面收集了基线人口统计学和临床数据。采用 Bazett、Fridericia、Hodges、Ashman、Framingham、Schlamowitz、Dmitrienko、Rautaharju 和 Sarma 校正公式计算 QTc 值。采用比较统计学、Spearman 相关分析、二元逻辑回归模型、受试者工作特征（ROC）曲线和决策曲线分析（DCA）进行分析。

结果

MACCE 组的 QTc 值明显高于对照组（P<0.05）。Sarma 公式（QTcBaz）的心率与 QTc 之间的 Spearman 相关分析显示存在中度正相关（ρ=0.46，P<0.001）。在多因素二元逻辑回归中，每个 QTc 变量均为 MACCE 的独立危险因素，其中 Sarma 公式衍生的 QTc（QTcSar）的危险比最高（OR=1.025）。ROC 曲线分析确定 QTcSar 的截断值为 446 ms 时具有最佳预测能力（AUC=0.734），灵敏度为 60.5%，特异性为 82.8%。DCA 表明，在 0 至 0.66 和 0.71-0.96 的高危阈值范围内，QTcSar 具有正净效益，而在临床中常用的 QTcBaz 在 0 至 0.99 的阈值范围内具有正净效益。