Calvin J E, Klein L W, VandenBerg B J, Meyer P, Condon J V, Snell R J, Ramirez-Morgen L M, Parrillo J E
Section of Cardiology, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill. 60612.
JAMA. 1995 Jan 11;273(2):136-41.
To validate the Braunwald classification of unstable angina as a predictor of in-hospital cardiac complications; to determine which factors of the Braunwald classification contributed significantly to this prediction; and to devise a method of combining these predictive factors into an overall odds ratio for complications.
A validation cohort of consecutive patients followed prospectively for in-hospital cardiac complications including myocardial infarction and death.
A community-based academic medical center.
A total of 393 patients admitted consecutively to the coronary care and intermediate care units with unstable angina.
Major cardiac complications including death, myocardial infarction, congestive heart failure, cardiogenic shock, and severe ventricular dysrhythmias.
Multiple logistic regression analysis identified four clinical factors used in the Braunwald classification that predicted the in-hospital occurrence of major cardiac complications: (1) myocardial infarction within less than 14 days (odds ratio [OR], 5.72; 95% confidence interval [CI], 1.92 to 16.97); (2) need for intravenous nitroglycerin (OR, 2.33; 95% CI, 1.31 to 4.17); (3) lack of beta-blocker or calcium channel blocker prior to admission (OR, 3.83; 95% CI, 1.55 to 9.42); and (4) baseline ST depression (OR, 2.81; 95% CI, 1.45 to 5.47). Two other clinical factors, diabetes and age, were also significant predictors. Validation of this model using parametric and nonparametric bootstrap techniques revealed excellent agreement between the CIs for adjusted ORs derived from the multiple logistic regression and those derived from the bootstrap.
The classification of unstable angina proposed by Braunwald includes four factors that predict risk of major in-hospital cardiac complications. Specific factors used in this classification can be combined with diabetes and age to better stratify risk of major cardiac complications in this disorder using a simpler model.
验证不稳定型心绞痛的Braunwald分类法作为住院心脏并发症预测指标的有效性；确定Braunwald分类法中的哪些因素对该预测有显著贡献；并设计一种方法将这些预测因素组合成并发症的总体比值比。
对连续患者组成的验证队列进行前瞻性随访，观察住院心脏并发症，包括心肌梗死和死亡。
一个基于社区的学术医疗中心。
共有393例因不稳定型心绞痛连续入住冠心病监护病房和中级护理病房的患者。
主要心脏并发症，包括死亡、心肌梗死、充血性心力衰竭、心源性休克和严重室性心律失常。
多因素logistic回归分析确定了Braunwald分类法中用于预测住院期间主要心脏并发症发生的四个临床因素：（1）14天内发生心肌梗死（比值比[OR]，5.72；95%置信区间[CI]，1.92至16.97）；（2）需要静脉使用硝酸甘油（OR，2.33；95%CI，1.31至4.17）；（3）入院前未使用β受体阻滞剂或钙通道阻滞剂（OR，3.83；95%CI，1.55至9.42）；（4）基线ST段压低（OR，2.81；95%CI，1.45至5.47）。另外两个临床因素，糖尿病和年龄，也是显著的预测因素。使用参数和非参数自抽样技术对该模型进行验证，结果显示多因素logistic回归得出的校正OR的CI与自抽样得出的CI之间具有良好的一致性。
Braunwald提出的不稳定型心绞痛分类法包含四个预测住院期间主要心脏并发症风险的因素。该分类法中使用的特定因素可与糖尿病和年龄相结合，以使用更简单的模型更好地分层该疾病中主要心脏并发症的风险。
