Krumholz H M, Howes C J, Murillo J E, Vaccarino L V, Radford M J, Ellerbeck E F
Department of Medicine, Yale School of Medicine and the Yale-New Haven Center for Outcomes Research and Evaluation, Connecticut 06520-8017, USA.
Am J Cardiol. 1997 Jul 1;80(1):11-5. doi: 10.1016/s0002-9149(97)00299-3.
We sought to validate a previously described clinical prediction rule for classifying left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). As part of the Connecticut cohort of the Cooperative Cardiovascular Project (CCP) pilot study, we identified 3,093 Medicare patients who had been admitted to hospitals throughout Connecticut with an AMI in 1992 and 1993. Retrospective chart review and detailed electrocardiogram interpretation were performed. Of the 1,891 patients with an interpretable EF, 1,378 (73%) had > or = 1 of the rule's exclusion criteria. Of the remaining 513 patients, the clinical prediction rule had a positive predictive value of 89% (i.e., 456 of 513 patients had an EF > or = 40%). In a multivariate model, presentation > 6 hours after the onset of chest pain, a history of bypass surgery, and diabetes mellitus were associated with patients in whom the rule did not correctly predict an EF > or = 40%. Excluding patients with these characteristics from the rule increased the positive predictive value from 89% to 93% and excluded an additional 239 patients. The EF could not be predicted among the patients who did not meet the rule's criteria. In conclusion, a previously published clinical prediction rule for the classification of the EF in patients after an AMI correctly classified 8 of every 9 eligible elderly patients as having an EF > or = 40%. Thus, while not performing as well as it did in the original study, our findings support the use of this rule in providing clinicians with an objective method for estimating an EF > or = 40% in a specific subset of elderly patients.
我们试图验证先前描述的用于急性心肌梗死（AMI）后左心室射血分数（LVEF）分类的临床预测规则。作为合作心血管项目（CCP）试点研究康涅狄格队列的一部分，我们确定了1992年和1993年在康涅狄格州各医院因AMI入院的3093名医疗保险患者。进行了回顾性病历审查和详细的心电图解读。在1891名可解读EF的患者中，1378名（73%）有该规则的≥1项排除标准。在其余513名患者中，临床预测规则的阳性预测值为89%（即513名患者中有456名EF≥40%）。在多变量模型中，胸痛发作后>6小时就诊、有搭桥手术史和糖尿病与该规则未能正确预测EF≥40%的患者相关。将具有这些特征的患者排除在该规则之外，可使阳性预测值从89%提高到93%，并额外排除239名患者。在不符合该规则标准的患者中无法预测EF。总之，先前发表的用于AMI后患者EF分类的临床预测规则能将每9名符合条件的老年患者中的8名正确分类为EF≥40%。因此，虽然我们的研究结果不如原始研究那样理想，但支持使用该规则为临床医生提供一种客观方法，用于估计特定老年患者亚组中的EF≥40%。
