Ong L, Green S, Reiser P, Morrison J
Am J Cardiol. 1986 Jan 1;57(1):33-8. doi: 10.1016/0002-9149(86)90947-1.
To examine the prognostic value of early radionuclide imaging in patients with transmural acute myocardial infarction, 222 patients in Killip class I and II were studied prospectively within 24 hours of the onset of symptoms. The 30-day mortality rate for the entire group was 11% (25 of 222). Univariate analysis indicated that an initial radionuclide left ventricular ejection fraction (EF) of less than 0.30 was associated with the greatest relative risk (RR = 6.6), although the percent of abnormally contracting regions (RR = 3.9) and thallium-201 defect index (RR = 3.3) were also significant risk factors. Stepwise logistic regression indicated that addition of EF resulted in the greatest improvement over the best clinical model (Killip class and chest radiographic findings) for the prediction of 30-day mortality (chi 2 improvement = 12.8, p less than 0.0005). Using the optimal model for prediction of mortality (EF and Killip class), a high-risk group with a 30-day mortality rate of 39% (90-day mortality 47%) and a low-risk group with a 30-day mortality rate of 3% (90-day mortality 4%) was identified. In clinically stable patients with transmural acute myocardial infarction, early assessment of EF in conjunction with clinical evaluation, is a valuable method for early identification of high-risk subsets.
为研究早期放射性核素成像对透壁性急性心肌梗死患者的预后价值，对222例Killip I级和II级患者在症状发作后24小时内进行了前瞻性研究。整个组的30天死亡率为11%（222例中的25例）。单因素分析表明，初始放射性核素左心室射血分数（EF）小于0.30与最大相对风险相关（RR = 6.6），尽管异常收缩区域百分比（RR = 3.9）和铊-201缺损指数（RR = 3.3）也是显著的危险因素。逐步逻辑回归表明，加入EF后，在预测30天死亡率方面，相对于最佳临床模型（Killip分级和胸部X线表现）有最大改善（卡方改善 = 12.8，p < 0.0005）。使用预测死亡率的最佳模型（EF和Killip分级），确定了一个30天死亡率为39%（90天死亡率47%）的高危组和一个30天死亡率为3%（90天死亡率4%）的低危组。在临床上稳定的透壁性急性心肌梗死患者中，结合临床评估对EF进行早期评估，是早期识别高危亚组的一种有价值的方法。
