Cardiovascular Department, Servicio de Cardiología, Hospital Universitario Virgen Macarena.
Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, Spain.
Coron Artery Dis. 2024 Nov 1;35(7):556-563. doi: 10.1097/MCA.0000000000001396. Epub 2024 Jun 3.
The aim of this study was to determine the best clinical predictors of acute heart failure needing mechanical ventilation (MV) in the first 48 h of evolution of patients admitted because of acute coronary syndrome (ACS).
We analyzed a cohort of patients admitted for ACS between February 2017 and February 2018. A pulmonary ultrasound was performed on admission and was considered positive (PE+) when there were three or more B-lines in two quadrants or more of each hemithorax. It was compared with N-terminal pro-B-type natriuretic peptide (NT-proBNP), peak troponin T-us value GRACE (Global Registry of Acute Coronary Events), CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology and American Heart Association guidelines - Bleeding Score), CACS (Canada Acute Coronary Syndrome risk score), and HAMIOT (Heart Failure after Acute Myocardial Infarction with Optimal Treatment score) scores, shock index, ejection fraction, chest X-ray, and Killip class at admission as predictors of MV in the first 48 h of admission.
A total of 119 patients were included: 54.6% with ST elevation and 45.4% without ST elevation. Twelve patients (10.1%) required MV in the first 48 h of evolution. The sensitivity of PE+ was 100% (73.5-100%), specificity 91.6% (84.6-96.1%), and area under the curve was 0.96 (0.93-0.96). The sensitivity of an NT-proBNP value more than 3647 was 88.9% (51.9-99.7%), specificity 92.1% (84.5-96.8%), and area under the curve was 0.905 (0.793-1). The κ statistic between both predictors was 0.579. All the other scores were significantly worse than PE + .
Lung ultrasound and a high NT-proBNP (3647 ng/L in our series) on admission are the best predictors of acute heart failure needing MV in the first 48 h of ACS. The agreement between both tests was only moderate.
本研究旨在确定急性冠状动脉综合征（ACS）患者入院后 48 小时内需要机械通气（MV）的急性心力衰竭的最佳临床预测因素。
我们分析了 2017 年 2 月至 2018 年 2 月期间因 ACS 入院的患者队列。入院时进行肺部超声检查，如果每个半胸的两个象限或更多象限有三个或更多 B 线，则认为是阳性（PE+）。它与 N 末端前 B 型利钠肽（NT-proBNP）、峰值肌钙蛋白 T-us 值 GRACE（全球急性冠状动脉事件注册）、CRUSADE（快速危险分层不稳定型心绞痛患者抑制不良结局与早期实施美国心脏病学院和美国心脏协会指南-出血评分）、CACS（加拿大急性冠状动脉综合征风险评分）和 HAMIOT（急性心肌梗死后心力衰竭伴最佳治疗评分）进行比较，入院时的休克指数、射血分数、胸部 X 线和 Killip 分级作为入院后 48 小时内 MV 的预测因素。
共纳入 119 例患者：ST 段抬高者占 54.6%，ST 段不抬高者占 45.4%。12 例（10.1%）患者在入院后 48 小时内需要 MV。PE+的灵敏度为 100%（73.5-100%），特异性为 91.6%（84.6-96.1%），曲线下面积为 0.96（0.93-0.96）。NT-proBNP 值大于 3647 的灵敏度为 88.9%（51.9-99.7%），特异性为 92.1%（84.5-96.8%），曲线下面积为 0.905（0.793-1）。两个预测因素之间的 κ 统计量为 0.579。所有其他评分均明显差于 PE+。
入院时肺部超声和高 NT-proBNP（本研究中为 3647ng/L）是 ACS 患者入院后 48 小时内需要 MV 的急性心力衰竭的最佳预测因素。两种检测方法的一致性仅为中等。
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