Powell L H, Thoresen C E
J Chronic Dis. 1985;38(3):253-63. doi: 10.1016/0021-9681(85)90068-2.
We studied the accuracy of predictions of long-term prognosis after infarction in a sample of 118 non-smoking, post-coronary males using: behavioral indices only; physiologic risk factors only; and a combination of behavioral indices and physiologic risk factors. To isolate valid behavioral indices, we measured 49 signs and symptoms of a lifestyle characterized by chronic struggle from videotapes of subjects undergoing a structured interview. Of these, 15 had a univariate relationship to recurrent cardiac events, and four--intensity, self-involvement, periorbital pigmentation and arousal while driving--had a multivariate relationship. Of six physiologic risk factors, one--the Peel Index--was related to recurrent cardiac events. Separately, each model achieved approximately 70% accuracy in classifying subjects into their future reinfarction status; jointly, predictive accuracy increased to 75%. The results suggest that living a lifestyle of chronic struggle increases risk for recurrent myocardial infarction, independently of the risk incurred by standard physiologic risk factors. The need for precise assessment of individual signs and symptoms of this lifestyle and implications for secondary prevention are discussed.
我们在118名非吸烟的冠心病男性样本中，研究了心肌梗死后长期预后预测的准确性，采用了以下方法：仅使用行为指标；仅使用生理风险因素；以及行为指标与生理风险因素相结合。为了分离出有效的行为指标，我们从接受结构化访谈的受试者录像带中测量了49种以长期挣扎为特征的生活方式的体征和症状。其中，15种与复发性心脏事件存在单变量关系，4种——强度、自我投入、眶周色素沉着和驾驶时的唤醒状态——存在多变量关系。在6种生理风险因素中，一种——皮尔指数——与复发性心脏事件有关。单独来看，每个模型在将受试者分类为未来再梗死状态时的准确率约为70%；综合起来，预测准确率提高到了75%。结果表明，长期挣扎的生活方式会增加复发性心肌梗死的风险，独立于标准生理风险因素所带来的风险。本文讨论了精确评估这种生活方式的个体体征和症状的必要性以及对二级预防的意义。
